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Importance of nutrient balance in severe congenital diaphragmatic hernia: A retrospective case-control study
Masahiro Zenitani1, Yoshiyuki Shimizu2, Masayuki Yoshida1
1Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Insights
Early enteral nutrition (EN) and adequate lipid intake, facilitated by naso-duodenal (ND) tube replacement, promote catch-up growth in infants with severe congenital diaphragmatic hernia (CDH).
Area of Science:
- Pediatric Surgery
- Neonatology
- Nutritional Science
Background:
- Severe congenital diaphragmatic hernia (CDH) frequently causes growth retardation in infants.
- Optimal nutritional strategies for these infants remain critical for improving outcomes.
Purpose of the Study:
- To determine appropriate nutrition and nutrient balance in early infancy for severe CDH patients.
- To identify factors associated with successful early growth in this population.
Main Methods:
- Retrospective case-control study of isolated CDH patients (2006-2022).
- Patients categorized into positive or negative weight gain velocity groups (1-3 months).
- Comparison of clinical variables and nutritional intake between groups.
Main Results:
- Earlier enteral nutrition (EN) start and higher naso-duodenal (ND) tube replacement rates were linked to positive weight gain.
- Infants with positive weight gain received significantly higher total calories, protein, and lipids at 1 month.
- Higher caloric intake, particularly lipids, was observed in the positive group at 2 and 3 months.
Conclusions:
- Early EN initiation, potentially enabled by timely ND tube replacement, supports catch-up growth.
- Adequate lipid administration appears crucial for promoting growth in infants with severe CDH.
Background & Aims:
Growth retardation is a common morbidity in infants with severe congenital diaphragmatic hernia (CDH). This study aimed to investigate the appropriate amount of nutrition and nutrient balance in early infants with severe CDH.
Methods:
This was a retrospective case-control study. Isolated CDH patients with more than half of the chest wall devoid of diaphragmatic tissue and treated between 2006 and 2022 were included. The patients were divided into positive (n = 16) or negative (n = 8) weight gain velocity groups in early infancy (from 1 to 3 months of age). Clinical variables and amount of nutrition were compared between the two groups.
Results:
The earlier start of enteral nutrition (EN) and higher replacement rate of the naso-duodenal (ND) tube were observed more frequently in the positive group than in the negative group. Regarding daily intake by both EN and parenteral nutrition (PN), total caloric intake and caloric intake of proteins and lipids were significantly higher in the positive group than in the negative group at 1 month of age. At 2 months, total caloric intake and caloric intake of lipids were significantly higher in the positive group than in the negative group. At 3 months of age, only caloric intake of lipid was significantly higher in the positive group than in the negative group.
Conclusions:
The early replacement of the ND tube may contribute to the early start of EN, which may subsequently lead to appropriate nutrient supplementation including adequate lipid administration, resulting in early catch-up growth.
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