CLINICAL EFFECTIVENESS OF TARGETED ENTERAL NUTRITION IN INFANTS WITH CONGENITAL HEART DISEASE COMPLICATED BY CHRONIC HEART FAILURE: A PROSPECTIVE STUDY

ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 1466 CLINICAL EFFECTIVENESS OF TARGETED ENTERAL NUTRITION IN INFANTS WITH CONGENITAL HEART DISEASE COMPLICATED BY CHRONIC HEART FAILURE: A PROSPECTIVE STUDY Rabbimova Dilfuza Toshtemirovna, MD – Associate Professor, Head of the Department of Propaedeutics of Children’s Diseases, S amarkand State Medical University, Samarkand, Uzbekistan Khalilova Manizha Abdurashidovna, Master – Samarkand State Medical University, Samarkand, Uzbekistan Abstract.Malnutrition is a prevalent and clinically significant complication in infants with congenital heart disease (CHD), particularly when associated with chronic heart failure (CHF). Nutritional deficits contribute to delayed growth, impaired immune function, and adverse surgical outcomes. Objective: To evaluate the clinical effectiveness of a structured enteral nutritional intervention in improving nutritional status among infants with CHD and CHF. Methods: A prospective, single-center study enrolled 18 infants (1–12 months) with CHD and CHF. Nutritional status was assessed using anthropometric measurements, biochemical markers, and the STRONGkids screening tool. Individualized target enteral nutrition was provided for 14 days. Paired comparisons were conducted to determine changes in nutritional and biochemical parameters. Results: At baseline, 74% of participants exhibited moderate or severe malnutrition. After 14 days of nutrition intervention, mean body weight increased by 10.3% (p < 0.05), mid-upper arm circumference and skinfold thickness improved significantly, and serum albumin and prealbumin levels rose (p < 0.05). The proportion of infants classified as high nutritional risk decreased from 100% to 11.1%. Conclusion: Early, targeted enteral nutrition yields significant improvements in anthropometric and biochemical indicators of nutritional status in infants with CHD and CHF. Integration of systematic nutritional support into pediatric cardiology care is recommended to optimize clinical outcomes. Keywords: congenital heart disease, chronic heart failure, enteral nutrition, malnutrition, infants, nutritional support. Introduction Malnutrition is a well-recognized complication in pediatric patients with congenital heart disease (CHD), particularly when accompanied by chronic heart failure (CHF). Infants with CHD frequently demonstrate compromised growth due to increased metabolic demands, feeding difficulties, chronic hypoxia, and altered nutrient absorption [1–3]. Malnutrition in this population not only predicts poorer physical development but is also associated with increased susceptibility to infections, prolonged hospital stays, and impaired postoperative recovery [4,5]. The identification and correction of nutritional deficits in infants with CHD have emerged as critical components of comprehensive care. Standardized screening tools such as the STRONGkids questionnaire have been validated for identifying children at high risk of malnutrition, but their utility in guiding intervention strategies in CHD populations remains under investigation [6]. ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 1467 In Russia, several studies have highlighted the prevalence of malnutrition in pediatric patients with CHD and emphasized the importance of structured enteral nutrition protocols to improve clinical outcomes [11–14]. This study aimed to assess the baseline nutritional status of infants with CHD complicated by CHF and evaluate the clinical effectiveness of a targeted enteral nutrition protocol on key anthropometric and biochemical markers. Materials and Methods Study Design and Participants A prospective, single-center study included 18 infants with echocardiographically confirmed CHD complicated by CHF. Participants were recruited from the pediatric cardiology department of a tertiary medical center between [start date] and [end date]. Inclusion criteria: age 1–12 months, clinical signs of CHF (Ross classification II–IV), availability for follow-up. Exclusion criteria: noncardiac chronic diseases, genetic syndromes associated with growth failure, acute infection at enrollment. Nutritional Assessment - Anthropometry: body weight, mid-upper arm circumference (MUAC), triceps skinfold thickness. -Biochemical markers: serum albumin, prealbumin. -Nutritional risk: STRONGkids score (≥4 indicating high risk) [6]. - Z-scores for weight-for-age, length-for-age, and weight-for-length calculated using WHO Anthro software. Intervention Protocol All infants received individualized enteral nutritional support for 14 days. Nutrition plans were based on energy requirements (~120–150 kcal/kg/day) and adjusted for fluid tolerance and CHF severity. High-calorie, high-protein enteral formulas were used, and feeding regimens tailored to each patient’s clinical status. Statistical Analysis IBM SPSS Statistics 25.0 was used. Continuous variables were expressed as mean ± SD. Paired ttests compared preand post-intervention measures; chi-square tests compared categorical variables. p < 0.05 was considered significant. Results Baseline Characteristics Characteristic Value Age, months (mean ± SD) 5.8 ± 1.9 Male / Female 10 (55.6%) / 8 (44.4%) Cyanotic CHD (%) 56% Acyanotic CHD (%) 44% CHF Functional Class (Ross) II: 72%; III: 20%; IV: 8% Moderate/Severe Malnutrition (%) 74% High STRONGkids Risk (%) 100% Nutritional Outcomes After 14 Days Parameter Baseline After 14 Days p-value Body weight, kg 4.00 ± 0.5 4.41 ± 0.6 <0.05 ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-12 1468 MUAC, cm 10.4 ± 0.6 11.1 ± 0.7 <0.05 Skinfold, mm 6.1 ± 1.0 7.4 ± 1.2 <0.05 Serum albumin, g/L 27.4 ± 2.2 31.5 ± 2.3 <0.05 Prealbumin, mg/dL 12.3 ± 2.5 17.6 ± 2.8 <0.05 STRONGkids highrisk (%) 100% 11.1% — Discussion This study demonstrates that structured enteral nutrition significantly improves nutritional status in infants with CHD complicated by CHF. At baseline, 74% of infants exhibited moderate to severe malnutrition, consistent with international [1–3] and Russian data [11–14]. Improvements in body weight, MUAC, skinfold thickness, serum albumin, and prealbumin indicate enhanced caloric intake and nutrient utilization. These markers are crucial predictors of immune competence and postoperative outcomes [7,8]. The STRONGkids tool effectively identified high-risk infants and monitored response to nutritional support. Short-term enteral nutrition interventions in high-risk populations are thus feasible and effective [9–11]. Limitations: Single-center design, small sample size, short follow-up period. Long-term effects beyond 14 days were not assessed. Conclusion Early implementation of targeted enteral nutrition in infants with CHD and CHF significantly improves anthropometric and biochemical markers of nutritional status. Routine nutritional screening and individualized support should be standard practice in pediatric cardiology. 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