# Preoperative Nutrition-Based Interventions in Children Undergoing Cardiac Surgeries—A Systematic Review and Meta-Analysis

## TL;DR

This review examines whether pre-surgery nutrition helps children undergoing heart surgery recover faster and safely.

## Contribution

The study is the first to systematically evaluate preoperative nutrition interventions in pediatric cardiac surgery.

## Key findings

- Some studies suggest shorter ICU and hospital stays with extended preoperative nutrition support.
- Observational data show reduced hospital stays and faster return to full feeding after surgery.
- No serious adverse events were reported from the interventions.

## Abstract

Objective: This systematic review aimed to evaluate the efficacy and safety of preoperative nutrition-based interventions on pre-, intra-, and postoperative outcomes in children undergoing cardiac surgical procedures. Methods: CENTRAL, MEDLINE, and EMBASE were systematically searched for interventional and observational studies comparing any nutritional preoperative intervention with a control or alternative strategy in pediatric patients undergoing cardiac surgery, up to July 2025. The main outcome was the postoperative length of stay in the intensive care unit (ICU). The certainty of evidence was assessed using the GRADE approach. Results: Nineteen studies were included (8 randomized controlled trials [RCTs], 1 non-randomized trial, and 10 observational studies), evaluating heterogeneous interventions or exposures, including fatty acids, vitamin D supplementation, and structured preoperative nutritional protocols. Two RCTs demonstrated shorter ICU and hospital stays with extended preoperative nutritional support (2 weeks vs. 1 week; n = 40; and 1 month vs. no support; n = 80). Observational data indicated an association between preoperative nutritional support and reduced hospital length of stay (meta-analysis of four studies; n = 278), as well as fewer days to achieve full enteral feeding postoperatively (meta-analysis of three studies; n = 138). No significant difference in postoperative ICU stay was observed between groups (meta-analysis of two studies; n = 175). No intervention-related serious adverse events were reported. The overall certainty of evidence was very low. Conclusions: This systematic review provides very low-certainty evidence suggesting that preoperative nutrition-based interventions in children undergoing cardiac surgery are safe and may offer clinical benefits. Substantial heterogeneity across studies underscores the need for well-designed trials and standardized preoperative nutritional protocols. PROSPERO number: CRD420251085196.