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Pediatr Int. 2019 Mar 19. doi: 10.1111/ped.13837. [Epub ahead of print]

The Impact of Nutrition in the Congenital Diaphragmatic Hernia Treatment.

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Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 594-1101, Japan.
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan.
Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.



The optimum enteral (EN) and parenteral nutrition (PN) regimes during acute management of congenital diaphragmatic hernia (CDH) remain unclear. We aimed to examine the effects of EN and PN on weight gain in CDH patients.


Multicenter retrospective cohort study including neonates with CDH (born 2006-2010; n = 105) who survived to discharge was conducted. Patients were divided as receiving PN of ≥ or <50 kcal/kg/day at 1 week of age, and EN of ≥ or <60 kcal/kg/day at 2 weeks of age. Changes in body weight at 30, 60, and 90 days of age were compared.


Higher EN group (n = 39) had greater weight gain than lower EN group (n = 66) (90 days: 2,501 g, 95% CI 2,294-2,710 g vs. 1,706 g, 95% CI 1,553-1,861 g; P <0.001). When patients received lower amount of EN, higher PN group (n = 24) had greater weight gain than lower PN group (n = 42) (90 days: 1,768g, 95% CI 1,574-1,961 g vs. 1,411 g, 95% CI 1,264-1,558 g; P = 0.004).


The amount of EN in the acute phase of CDH management is essential for weight gain during infancy. When patients are intolerant to adequate EN, supportive PN is also essential. This article is protected by copyright. All rights reserved.


enteral nutrition; neonatal care; neonatal intensive care; neonatal surgery; parenteral nutrition


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