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Nutritional morbidity in survivors of congenital diaphragmatic hernia
C S Muratore1, S Utter, T Jaksic
1Department of Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Insights
Congenital diaphragmatic hernia (CDH) survivors often face nutritional issues, with prolonged ventilation and patch repair increasing risks of failure to thrive and reflux. Careful nutritional monitoring is crucial for these patients.
Area of Science:
- Pediatric Surgery
- Neonatology
- Nutritional Science
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect impacting infant survival and development.
- Long-term nutritional sequelae in CDH survivors require comprehensive understanding and management.
Purpose of the Study:
- To detail the nutritional outcomes in survivors of congenital diaphragmatic hernia (CDH).
- To identify factors influencing nutritional morbidity in CDH patients.
Main Methods:
- Retrospective analysis of 121 CDH survivors (1990-2000).
- Regression analysis to assess impact of Apgar score, birth weight, ECMO, and patch repair on nutritional outcomes.
- Evaluation of factors predicting gastrostomy, fundoplication, and oral aversion.
Main Results:
- 56% of patients were below the 25th percentile for weight in their first year.
- Prolonged ventilation and patch repair independently predicted failure to thrive requiring gastrostomy.
- Patch repair predicted the need for fundoplication due to gastroesophageal reflux.
- Severe oral aversion affected 24% of patients, linked to prolonged ventilation and oxygen need at discharge.
Conclusions:
- Nutritional problems are a significant source of morbidity in CDH survivors, especially during the first year.
- Patients with prolonged intubation and prosthetic patch repair experienced worse nutritional outcomes.
- Aggressive nutritional management did not prevent 56% of patients from remaining underweight, highlighting the need for vigilant assessment in high-risk CDH patients.
Purpose:
The purpose of this report is to detail the nutritional sequelae seen in survivors of congenital diaphragmatic hernia (CDH) followed in a multidisciplinary clinic.
Methods:
Data on 121 surviving CDH patients seen between 1990 and 2000 were collected. Regression analysis was used to determine the impact of factors such as Apgar score, birth weight, extracorporeal membrane oxygenation (ECMO), and patch repair on outcomes associated with nutritional morbidity.
Results:
There were 100 left and 21 right CDH defects. Mean birth weight and 5-minute Apgar score were 3.1 kg (+/-0.8) and 6.8(+/-2), respectively. Extracorporeal membrane oxygenation was required in 43 (36%) patients and patch repair in 39 (32%). A gastrostomy was required in 39 (32%) patients and a fundoplication in 23 (19%) patients. The side of the defect did not affect the frequency of these procedures. Fifty-six percent of patients were below the 25th percentile for weight during most of their first year. Regression analysis found that duration of ventilation (P <.001) and the presence of a patch repair (P =.03) were independent variables predictive of failure to thrive thereby requiring a gastrostomy tube. Patch repair also was predictive of need for subsequent fundoplication caused by gastroesophageal reflux (P <.001). Twenty-nine patients (24%) had severe oral aversion. Risk factors were prolonged ventilation (P =.001) and oxygen requirement at discharge (P =.015). Two thirds of these patients subsequently improved.
Conclusions:
Nutritional problems continue to be a source of morbidity for survivors of CDH, particularly in the first year of life. Not surprisingly, patients who had prolonged intubation and prosthetic material at the gastroesophageal junction fared worse. Despite aggressive nutritional management, 56% of the population remained below the twenty-fifth percentile for weight. These data show the need for careful nutritional assessment in all CDH patients, especially those at high risk for malnutrition.
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