Risk factors for and developmental relation of delayed oral nutrition in infants with congenital diaphragmatic hernia

Area of Science:

• Pediatric Surgery
• Neonatology
• Developmental Pediatrics

Background:

• Congenital diaphragmatic hernia (CDH) is a complex birth defect requiring intensive neonatal care.
• Nutritional support and feeding progression are critical aspects of CDH management.
• Developmental outcomes in CDH survivors are a significant concern.

Purpose of the Study:

• To identify risk factors associated with delayed oral nutrition in infants diagnosed with congenital diaphragmatic hernia (CDH).
• To determine the impact of delayed oral nutrition on developmental delay at 18 months of age in CDH patients.

Main Methods:

• Retrospective single-center cohort study of 80 infants with isolated CDH treated between 2006 and 2020.
• Evaluation of clinical parameters to identify risk factors for delayed oral nutrition, defined as taking ≥30 days from mechanical ventilation weaning to tube feeding weaning.
• Multivariate analysis to determine independent risk factors for delayed oral nutrition and its association with developmental delay.

Main Results:

• Twenty-six out of 80 infants (32.5%) experienced delayed oral nutrition.
• Independent risk factors for delayed oral nutrition included large defect size (>50% to nearly entire defect) and ventilation for ≥9 days (adjusted ORs 4.65 and 6.02, respectively).
• Delayed oral nutrition was significantly associated with a higher probability of developmental delay at 18 months (crude OR 4.16).

Conclusions:

• Large defect size and prolonged mechanical ventilation (≥9 days) are significant independent risk factors for delayed oral nutrition in CDH infants.
• Delayed oral nutrition is a potent predictor of developmental delay in infants with congenital diaphragmatic hernia.
• Active developmental care is crucial for CDH patients experiencing delayed oral nutrition.