Biomarkers for feeding intolerance in infants with complex heart defects undergoing palliation surgery.

OBJECTIVES

We evaluated whether serum biomarkers reflecting intestinal membrane integrity will serve as predictors for post-operative feeding intolerance (FI) in patients with congenital heart disease (CHD).

METHODS

We enrolled infants ≥ 35 weeks gestational age, aged 0-6 months, with complex CHD undergoing palliation surgery. After surgery, blood samples were obtained prior to the initiation of enteral feeds, at 7 and 14-days post feeding initiation, and at times of symptoms of FI and/or necrotizing enterocolitis (NEC). Plasma biomarkers of tight junction integrity (claudin-3), villus injury (I-FABP), and clinical outcomes were analyzed.

RESULTS

Twenty-four infants were included in the analysis, and twelve of those had FI and/or symptoms of NEC. Patients in the FI group had higher peak claudin-3 than controls (p < 0.001). Claudin-3 was overall higher during 28 days after surgery in patients with FI. Pre-feeding I-FABP levels were higher for the FI group vs. control group (p = 0.006) but did not rise afterward. Higher cardiopulmonary bypass time and maximal lactate was associated with FI. Weight for length at discharge was significantly lower in patients with FI.

CONCLUSIONS

We suggest that, when measured sequentially, plasma levels of I-FABP and claudin-3 may help to predict children with CHD at risk of feeding intolerance post cardiac surgery. If further validated in larger cohort, these biomarkers may aid in optimizing feeding protocols aimed at reducing sequelae such as NEC.