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Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia

Mélina Bourezma1, Sébastien Mur2,3,4, Laurent Storme2,3,4

  • 1CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France.

Journal of Clinical Medicine
|March 29, 2023
PubMed

Insights

Prophylactic gastrostomy and surgical reoperation are key factors delaying oral feeding autonomy in infants with congenital diaphragmatic hernia (CDH). These interventions, along with potential bowel obstruction, significantly impact a child's ability to feed independently.

Area of Science:

  • Pediatric Surgery
  • Neonatology
  • Gastroenterology

Background:

  • Congenital diaphragmatic hernia (CDH) presents significant challenges in pediatric care, particularly concerning nutritional and digestive health.
  • Achieving oral feeding autonomy is a critical milestone for patients with CDH, impacting their overall management and long-term outcomes.

Purpose of the Study:

  • To identify perinatal risk factors associated with delayed oral feeding autonomy in infants diagnosed with congenital diaphragmatic hernia.
  • To analyze antenatal, postnatal, and perisurgical data to understand the predictors of feeding independence.

Main Methods:

  • A monocentric cohort study included 138 patients with CDH, with 84 analyzed after exclusions.
  • Patients were categorized based on achieving oral feeding autonomy at hospital discharge versus requiring nutritional support.
  • Statistical analysis, adjusted for patch repair necessity, examined various clinical factors.

Main Results:

  • Prophylactic gastrostomy was significantly associated with delayed oral feeding autonomy (OR adjusted: 16.3).
  • Surgical reoperation also emerged as a significant risk factor for delayed oral feeding (OR adjusted: 5.1).
  • Factors like lung-to-head ratio, liver/stomach position, and operative duration were not significantly related to feeding autonomy.

Conclusions:

  • Over one-third of CDH patients experience delayed oral feeding autonomy.
  • Prophylactic gastrostomy and surgical reoperations are identified as significant risk factors impacting feeding independence.
  • Bowel obstruction may also affect oral feeding autonomy, suggesting a need for individualized assessment of prophylactic gastrostomy.
Abstract

Keywords:
congenital diaphragmatic herniafailure to thrivegastrostomyoral feeding autonomysurgical reintervention

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