Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: a randomized clinical trial.

Abstract

To determine the impact of rapid advancement to more concentrated formula on weight gain and duration of hospitalization for infants after cardiac surgery. We performed a double-blinded, randomized trial of rapid advancement to higher achieved formula concentration for postoperative infants younger than 1 year of age. After transfer to the inpatient ward from the critical care unit, infants were randomly assigned to rapid advancement to a higher achieved formula concentration (2-day transition) or usual care (5-day transition, lower concentration target). The adequacy of energy intake (expressed as the median percentage of the estimated energy requirement) before discharge from the hospital was 98% in the intervention versus 78% in the usual care group ( P = .01). Before discharge, the median rate of weight gain was greater in the rapid advancement (20 g/d) versus the usual care group (loss of 35 g/d, P < .03). The median postoperative duration of stay on the cardiology inpatient unit was 5 days for the intervention versus 6 days for the usual care group ( P < .05). Rapid advancement to higher achieved formula concentration significantly improved energy intake and weight gain and decreased duration of postoperative hospital stay in infants after cardiac surgery.