Malnutrition Worsens Surgical Outcomes After Repair of CHD Despite clear evidence that post-operative malnutrition worsens surgical outcomes for infants with CHD, almost two thirds of these patients do not receive recommended calorie or protein requirements over the first 7 post-operative days. As even brief periods of malnutrition in infancy have permanent negative effects on neurocognitive outcome, enteral nutrition (EN) withheld post-operatively may worsen long-term neurocognitive outcome for infants with CHD. Strategies to improve safe delivery of early EN, by monitoring intestinal epithelial health to detect early intestinal hypoperfusion, could improve both short-term operative and long-term neurocognitive outcomes.