Factors Influencing the Timing of Enteral Nutrition Tolerance in Pediatric Patients Following Open-Heart Surgery: A Retrospective Study in a Referral Center in Iran Publisher



Mirzaaghayan M R ; Gharib B ; Heidari S ; Rafati Navaei M ; Rajabi M M
Source: Journal of Iranian Medical Council Published:2026

Abstract

Background: Congenital Heart Disease (CHD) is a leading cause of morbidity and mortality in children, with open-heart surgery being a critical intervention. Early initiation of Enteral Nutrition (EN) after surgery is essential for recovery; however, few studies have explored the factors that influence the timing of EN tolerance. This study aimed to identify the factors affecting the timing of EN tolerance in pediatric patients following open-heart surgery. Methods: A retrospective study was conducted on pediatric patients who underwent open-heart surgery at Children’s Medical Center, Tehran, between July 2018 and March 2019. Medical records were reviewed to assess factors such as patient characteristics, duration of mechanical ventilation, sternum status, and the day EN was tolerated. The statistical analysis was performed in SPSS version 24 using Pearson correlation, independent t-test, One-way analysis of variance (ANOVA), and multiple linear regression analysis. The significance level was set at 0.05. Results: The medical records of 109 patients were analyzed. EN was tolerated at an average of 8.67 days post-surgery. Univariate analysis showed significant associations between late EN tolerance and lower weight (p=0.03), longer mechanical ventilation duration (p<0.001), and open sternum status (p=0.02). However, multiple linear regression identified duration of mechanical ventilation as the sole significant predictor of EN tolerance time (p<0.001). Conclusion: The results identified prolonged mechanical ventilation as the primary predictor of late EN tolerance in pediatric cardiac surgery patients. Further studies are needed to validate this finding and to explore additional factors influencing EN tolerance. © 2026, Journal of Iranian Medical Council.