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Research: Achieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge

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Research: Achieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge

J Pediatr Surg

. 2021 Mar 26;S0022-3468(21)00282-7. doi: 10.1016/j.jpedsurg.2021.03.048. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/33888352/

Achieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge

K Taylor Wild 1Dana Bartholomew 2Taryn M Edwards 2Elizabeth Froh 3Diane L Spatz 3Matthew Huber 4Holly L Hedrick 2Ursula S Nawab 4Affiliations expand

Abstract

Background/purpose: To evaluate the enteral feeding requirements, including caloric provisions, of infants with CDH in relation to growth patterns.

Methods: A retrospective observational study was conducted on infants with CDH between August 2012 and March 2017. Electronic medical records were reviewed to extract detailed infant feeding data and anthropometric measurements at monthly intervals until discharge. Statistical methods of analysis included generalized linear models, Pearson correlation coefficient, Analysis of variance (ANOVA), Kruskal-Wallis, Wilcoxon rank sum, and Fisher’s Exact tests.

Results: Among 149 infants with CDH, 45% (n = 67) met criteria for malnutrition at discharge. Maternal human milk (HM) was initiated in 95% of infants (n = 142) and continued in 79% of infants (n = 118) at discharge. Overall, 50% received fortification of feeds, including 60% (n = 89) of formula fed infants compared to only 21% (n = 31) of HM fed infants (p<0.001). Infants fed formula had lower weight-for-length z-scores at discharge compared to those fed HM.

Conclusions: Infants receiving HM demonstrated improved growth compared to formula fed infants. However, higher calorie feeding regimens need to be initiated earlier to improve growth velocity. Prompt recognition of malnutrition and growth failure with aggressive supplementation may improve the overall growth of infants with CDH and has the potential to improve long term neurodevelopmental outcomes.

Keywords: Congenital diaphragmatic hernia (CDH); Gastroesophageal reflux/disease; Growth; Human milk; Nutrition.

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