Nutrition in congenital diaphragmatic hernia: How and when?

Survival for infants with congenital diaphragmatic hernia (CDH) has improved, but they continue to face significant nutritional morbidity. They are at risk of growth failure, malnutrition, gastroesophageal reflux disease (GERD), oral aversion, and the need for nutritional tube feeding support after the initial hospitalization. Malnutrition and poor nutritional outcomes impact neurodevelopment, underlining the importance of addressing these issues. Available evidence in this area is scarce, and controversies remain about the timing and mode of enteral feeding in the peri-operative period, the role of enteral nutrition on extracorporeal membrane oxygenation (ECMO), and nutritional growth targets for infants with CDH. In this manuscript, we discuss enteral and parenteral targets for infants with CDH, growth targets, the timing and advancement of enteral feeding. In addition, we discuss post-discharge nutritional support, identify gaps in the current literature and address parental concerns around nutrition and growth in infants with CDH.