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J Pediatr Surg. 2015 Jan;50(1):74-7. doi: 10.1016/j.jpedsurg.2014.10.003. Epub 2014 Oct 17.

Nutritional outcomes in survivors of congenital diaphragmatic hernia (CDH)-factors associated with growth at one year.

Author information

1
Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
2
Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
3
Division of Gastroenterology and Nutrition, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
4
Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States; Division of Critical Care Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States. Electronic address: nilesh.mehta@childrens.harvard.edu.

Abstract

BACKGROUND:

Malnutrition is prevalent among congenital diaphragmatic hernia (CDH) survivors. We aimed to describe the nutritional status and factors that impact growth over the 12-months following discharge from the pediatric intensive care unit (PICU) in this cohort.

METHODS:

CDH survivors, who were discharged from the PICU from 2000 to 2010 with follow-up of at least 12months, were included. Nutritional intake, anthropometric, and clinical variables were recorded. Multivariable linear regression was used to determine factors associated with weight-for-age Z-scores (WAZ) at 12months.

RESULTS:

Data from 110 infants, 67% male, 50% patch repair, were analyzed. Median (IQR) WAZ for the cohort was -1.4 (-2.4 to -0.3) at PICU discharge and -0.4 (-1.3 to 0.2) at 12-months. The percentage of infants with significant malnutrition (WAZ<-2) decreased from 26% to 8.5% (p<0.001). Patch repair (p=0.009), protein intake<2.3g/kg/day (p=0.014), and birth weight (BW)<2.5kg (p<0.001) were associated with lower WAZ at 12-months.

CONCLUSIONS:

CDH survivors had a significantly improved nutritional status in the 12-months after PICU discharge. Patch repair, lower BW, and inadequate protein intake were significant predictors of lower WAZ at 12-months. A minimum protein intake in the PICU of 2.3g/kg/day was essential to ensure optimal growth in this cohort.

KEYWORDS:

Congenital diaphragmatic hernia; Growth; Illness-related malnutrition; Nutrition; Protein

PMID:
25598097
DOI:
10.1016/j.jpedsurg.2014.10.003
[Indexed for MEDLINE]

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