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Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia
Ulla Lei Larsen1,2, Gitte Zachariassen2,3, Sören Möller2
1Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Insights
Early enteral nutrition is feasible for infants with congenital diaphragmatic hernia (CDH). This approach may reduce the need for parenteral nutrition and speed up full enteral feeding post-surgery.
Area of Science:
- Pediatric Surgery
- Neonatal Nutrition
- Critical Care Medicine
Background:
- Nutritional support for congenital diaphragmatic hernia (CDH) patients is complex, especially during neonatal and postoperative phases.
- Early enteral nutrition strategies are debated for symptomatic CDH infants.
Purpose of the Study:
- To evaluate the feasibility of early enteral nutritional support in symptomatic CDH infants.
- To identify factors associated with achieving full enteral nutrition.
- To analyze infant weight at birth, discharge, and 18 months.
Main Methods:
- Retrospective data collection on nutrition type, volume, and parenteral support.
- Introduction of enteral feeding from day 1, with stepwise increases (breast milk preferred).
- Resumption of enteral feeding on the first postoperative day after CDH repair.
Main Results:
- 45 CDH infants were identified between 2011-2020; 1-year mortality was 17.8%.
- Postoperative enteral nutrition targets (120 and 160 mL/kg/d) were achieved within a median of 6.5 and 10.6 days, respectively.
- 68.9% required supplemental parenteral nutrition for a median of 8 days; no enteral feeding complications were reported.
Conclusions:
- Early enteral nutrition is feasible in CDH infants.
- This approach shows potential for reducing reliance on parenteral nutrition.
- Early enteral feeding may shorten the time to achieve full enteral nutrition postoperatively.
Objectives:
Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months.
Methods:
We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database.
Results:
From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0-26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6-12.6) and 10.6 (7.6-21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5-18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported.
Conclusion:
Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.
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