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Growth failure and early recurrence in congenital diaphragmatic hernia: An international cohort study
Rachel C Bordelon1, Kylie I Holden1, Charles C Miller2
1Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, Suite 5.258, Houston, TX, 77030, USA.
Insights
Growth failure (GF) in congenital diaphragmatic hernia (CDH) survivors is linked to a higher risk of early hernia recurrence. Addressing growth challenges through targeted nutrition may reduce recurrence rates in these patients.
Area of Science:
- Pediatric Surgery
- Neonatology
- Growth and Development
Background:
- Growth failure (GF) is a frequent complication in congenital diaphragmatic hernia (CDH) survivors.
- The impact of growth challenges on CDH morbidity, specifically hernia recurrence, requires further clarification.
- Current CDH nutritional guidelines may need refinement regarding the relationship between growth and adverse outcomes.
Purpose of the Study:
- To investigate the association between growth failure (GF) and early recurrence in congenital diaphragmatic hernia (CDH) patients.
- To determine the prevalence and severity of GF among CDH survivors.
- To identify GF as a potential risk factor for CDH recurrence.
Main Methods:
- A multicenter cohort study retrospectively analyzed prospective data from the CDH Study Group (CDHSG) registry.
- Weight-for-age Z-scores (WAZ) were calculated for CDH survivors (born 2007-2023), with GF defined as WAZ <-2.0 at discharge.
- Non-parametric tests and logistic regression were used to analyze the data.
Main Results:
- Among 4,931 CDH survivors, 14.6% experienced GF.
- Hernia recurrence occurred in 3.3% of survivors, with a significantly higher rate in those with GF (6.4% vs. 2.8%, p<0.001).
- GF was associated with an 80% increased odds of early recurrence (aOR 1.8, p=0.007).
Conclusions:
- Growth failure (GF) is a significant risk factor for early recurrence in congenital diaphragmatic hernia (CDH).
- Targeted nutritional interventions are crucial for potentially mitigating CDH recurrence.
- Further research should focus on center-specific practices and long-term outcomes related to nutrition and growth in CDH survivors.
Purpose:
The primary objective was to determine whether growth failure (GF) is associated with early recurrence in congenital diaphragmatic hernia (CDH). The secondary objective was to characterize the prevalence and severity of GF in CDH survivors.
Background:
GF is common among CDH survivors, yet it is unclear how growth challenges affect overall morbidity, including hernia recurrence. CDH-specific nutritional guidelines include high calorie and protein targets during periods of acute illness but may benefit from clarifying the relationship between growth and adverse outcomes in this population.
Methods:
This multicenter cohort study retrospectively analyzed prospectively collected data from the CDH Study Group (CDHSG) registry. Weight-for-age Z-scores (WAZ) were calculated for CDH survivors born between 2007 and 2023 and GF was defined as WAZ <-2.0 at discharge from birth admission. Non-parametric tests and logistic regression analyses were employed.
Results:
Among 4931 CDH survivors, median gestational age and birth weight were 38 weeks and 3.1 kg, respectively (birth WAZ -0.24). Left-sided defects predominated (4205), with expected distribution by CDHSG stage: A (16 %), B (44 %), C (31 %), D (8 %). GF occurred in 14.6 % (720). Hernia recurrence occurred in 3.3 % (163), more commonly in those with GF: 6.4 % (46/720) versus 2.8 % (117/4211) (p < 0.001). GF patients had 80 % increased odds of early recurrence (adjusted odds ratio 1.8; 95 % CI 1.2-2.4; p = 0.007).
Conclusions:
GF is a potentially modifiable risk factor for early CDH recurrence, underscoring the need for targeted nutritional protocols. Future studies should evaluate center-specific practices and assess long-term recurrence risk related to nutrition and growth.
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