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Congenital Diaphragmatic Hernia and Growth to 12 Years
Lisette Leeuwen1, Daphne S Mous1, Joost van Rosmalen2
1Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands;and.
Insights
Children with congenital diaphragmatic hernia experience persistent poor growth into childhood. Early nutritional support is crucial for improving growth outcomes in these patients.
Area of Science:
- Pediatric surgery
- Growth and development
- Neonatal intensive care
Background:
- Congenital diaphragmatic hernia (CDH) is associated with growth problems in early life.
- Longitudinal growth patterns beyond infancy in CDH patients remain poorly understood.
Purpose of the Study:
- To evaluate the longitudinal growth of patients with congenital diaphragmatic hernia until 12 years of age.
- To determine if growth deficits persist throughout childhood in CDH survivors.
Main Methods:
- Prospective study of 172 CDH patients (43 treated with extracorporeal membrane oxygenation [ECMO]) from 1999-2014.
- Calculation of height-for-age (HFA) and weight-for-height Z-scores at multiple time points up to 12 years.
- Analysis using general linear models to assess growth trajectories.
Main Results:
- Weight-for-height Z-scores declined by 1 year of age in both ECMO and non-ECMO groups.
- Height-for-age Z-scores deteriorated between 1-5 years in ECMO patients and 2-5 years in non-ECMO patients.
- At 12 years, mean HFA Z-scores remained below normal in both groups, indicating persistent poor linear growth.
Conclusions:
- Linear growth deficits in CDH patients persist until at least 12 years of age.
- The observed growth pattern suggests inadequate nutrition during infancy.
- Early and continuous nutritional assessment and intervention are recommended for CDH patients throughout childhood.
Objectives:
Growth problems are reported in patients with congenital diaphragmatic hernia during the first years of life. However, it is unknown if poor growth persists during childhood. We therefore evaluated growth of patients longitudinally until 12 years of age.
Methods:
This prospective study included 172 patients (43 treated with extracorporeal membrane oxygenation [ECMO]) born from 1999 to 2014. Z scores of height-for-age (HFA), weight-for-height, and distance-to-target height were calculated at 6 months of age and at 1, 2, 5, 8, and 12 years of age. Data were analyzed by using general linear models.
Results:
At 1 year of age, the mean weight-for-height z score had declined in ECMO (-1.30, 95% confidence interval: -1.62 to -0.97) and non-ECMO patients (-0.72, 95% confidence interval: -0.91 to -0.54; P < .05). Thereafter in ECMO patients, the mean HFA z score deteriorated between 1 (-0.43, 95% confidence interval: -0.73 to -0.13) and 5 years of age (-1.08, 95% confidence interval: -1.38 to -0.78; P < .01). In non-ECMO patients, the mean HFA z score deteriorated between 2 (-0.35, 95% confidence interval: -0.53 to -0.17) and 5 years of age (-0.56, 95% confidence interval: -0.75 to -0.37; P = .002). At 12 years of age, the mean HFA z score was still less than the norm in both groups: ECMO (-0.67, 95% confidence interval: -1.01 to -0.33) versus non-ECMO (-0.49, 95% confidence interval: -0.77 to -0.20; P < .01). Adjusting for target height improved the mean height z scores but did not bring them to normal range.
Conclusions:
Poor linear growth persisted at 12 years of age. The pattern of early deterioration of weight gain followed by a decline in linear growth is suggestive of inadequate nutrition during infancy. Therefore, nutritional assessment and intervention should be started early and should be continued during childhood.
