Neonatal and pediatric nutritional care: a modified Delphi consensus on dietary management for infants with congenital heart disease in four Middle Eastern countries

Background In the absence of localized guidelines for the Middle East region, management of infant malnutrition secondary to congenital heart disease (CHD) can lead to suboptimal outcomes and may aggravate patient conditions. In this consensus document, we aimed to guide health care professionals on care pathways and establish regionally relevant recommendations for the nutritional assessment and management of infants with CHD. Methods Fifteen experts from four Middle Eastern countries participated in a two-round modified Delphi process. The included statements were initially developed following a literature review and subsequently refined based on feedback from a steering committee of five experts preselected from the panelists’ group for the first voting round. The second voting round, involving the other ten panelists, determined the final voting results. Follow-up discussions were utilized when needed. Consensus was predefined as ≥80% agreement, and statements meeting this threshold were included in the final document. Results Consensus was reached with a total of 43 statements, representing 87.8% of the suggested statements. The consensus statements established essential components and cut-off points for diagnosing malnutrition, specified values for enteral and parenteral feeding, caloric and fluid requirements and management, feeding practices and use of formula, and care in acute and critical settings. The highest agreement level was associated with the perioperative nutrition recommendations, while nutritional support recommendations faced the largest variability in response. In the latter, areas where a heterogeneity in clinical practice was observed, reflected by the lack of consensus, were identified. Conclusion This consensus document provides a general framework for the assessment, management, and follow-up of infants with CHD with compromised nutritional status in four Middle Eastern countries, bridging the gap between existing international guidelines and real-world clinical practice.