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Growth Restriction Beginning in Early Infancy Among Survivors of Congenital Diaphragmatic Hernia: A Single-Center
Tomonori Sunakawa1, Sota Iwatani1, Akiko Yokoi2
1Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan.
Insights
Congenital diaphragmatic hernia (CDH) survivors often face growth restriction (GR) starting in infancy. While GR improves over time, long-term monitoring and support are crucial for these children.
Area of Science:
- Pediatric Surgery
- Neonatology
- Developmental Pediatrics
Background:
- Congenital diaphragmatic hernia (CDH) survivors frequently experience growth restriction (GR).
- The precise timing and progression of GR in CDH survivors are not well-documented.
- Understanding GR onset is critical for optimizing long-term outcomes in CDH patients.
Purpose of the Study:
- To determine the frequency of GR at various postnatal ages in CDH survivors.
- To identify risk factors associated with the development and persistence of GR.
- To inform clinical management strategies for growth in CDH survivors.
Main Methods:
- Retrospective chart review of prenatally diagnosed CDH patients (2011-2020).
- Assessment of height and weight Z-scores at 1, 2, 3, 6, 12, 18, and 36 months.
- Statistical analysis to identify factors associated with GR (Z-score < -2.0).
Main Results:
- GR was observed in a significant proportion of patients, peaking at 63% at 2 months.
- Persistent GR up to 6 months was linked to lower birth weight, pulmonary vasodilator use, and post-discharge asthma.
- A trend towards catch-up growth was noted after the initial infancy period.
Conclusions:
- Growth restriction in CDH survivors typically emerges in early infancy.
- GR shows a pattern of improvement over time, suggesting potential for catch-up growth.
- Long-term growth surveillance and targeted nutritional/respiratory support are essential post-discharge for CDH survivors.
Abstract:
A significant number of congenital diaphragmatic hernia (CDH) survivors experience growth restriction (GR), but the timing of its onset is not well studied. This single-center retrospective study evaluated the frequency of GR at specific postnatal ages and associated risk factors. We reviewed charts of prenatally diagnosed CDH patients delivered between 2011 and 2020, with follow-up until December 2022. Body height and weight Z-scores were assessed at 1, 2, 3, 6, 12, 18, and 36 months of age. GR, defined as a Z-score below -2.0, was observed in 32%, 63%, 50%, 50%, 48%, 42%, and 24% of patients at these ages, respectively. Persistent GR up to 6 months was associated with lower birth weights, pulmonary vasodilator use at discharge, and asthma after discharge. GR begins in early infancy in CDH survivors but improves over time with catch-up growth, highlighting the need for long-term growth monitoring and nutritional/respiratory support after discharge.
