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Achieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge
K Taylor Wild1, Dana Bartholomew2, Taryn M Edwards2
1Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Division of Human Genetics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States.
Insights
Infants with congenital diaphragmatic hernia (CDH) fed human milk showed better growth. Earlier, higher-calorie feeding regimens are crucial for improving growth velocity and neurodevelopmental outcomes in these infants.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Nutritional Science
Background:
- Congenital diaphragmatic hernia (CDH) poses significant challenges to infant growth and development.
- Nutritional support is critical for managing infants with CDH.
Purpose of the Study:
- To evaluate enteral feeding requirements and caloric provisions for infants with CDH.
- To assess the relationship between feeding practices and growth patterns in infants with CDH.
Main Methods:
- Retrospective observational study of 149 infants with CDH (August 2012 - March 2017).
- Analysis of electronic medical records for feeding data and anthropometric measurements.
- Statistical analysis using generalized linear models, correlation, ANOVA, and non-parametric tests.
Main Results:
- 45% of infants with CDH were malnourished at discharge.
- Human milk (HM) was initiated in 95% of infants; 79% continued HM at discharge.
- Formula-fed infants had lower weight-for-length z-scores than HM-fed infants; HM feeding was associated with improved growth.
Conclusions:
- Human milk promotes better growth in infants with CDH compared to formula.
- Earlier initiation of higher-calorie feeding regimens is recommended to enhance growth velocity.
- Aggressive nutritional management is vital for improving growth and potentially long-term neurodevelopmental outcomes in CDH infants.
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.
