Weight gain velocity and adequate amount of nutrition for infants with congenital diaphragmatic hernia

Abstract

Purpose Growth retardation is a severe morbidity in infants with congenital diaphragmatic hernia (CDH). This study aimed to determine when catch-up growth starts in infants with CDH and to determine the adequate amount of nutrition required during catch-up growth. Methods This was a multicenter retrospective cohort study involving neonates with isolated CDH (born 2006-2010; n = 98). Weight gain velocity (WGV) was calculated using body weight Z-scores. The minimum required weight gain was defined as WGV ≥ 0. Patients were dichotomized into severe and non-severe cases according to diaphragmatic defects. Results Average monthly WGV changed from < 0 to ≥ 0 at 2 months of age. Total caloric intake at 2 months of age was lower when the WGV between 1 and 3 months was < 0 in both severe cases [122 (95% confidence interval (CI) 116-128) vs. 97 (95% CI 84-110) kcal/kg/day, p = 0.02] and non-severe cases [115 (95% CI 110-120) vs. 99 (95% CI 87-111) kcal/ kg/day, p < 0.001)]. Conclusion Catch-up growth started at approximately 2 months of age. During this period, total caloric intake of > 122 kcal/ kg/day was needed to avoid decreases in the body weight Z-score in severe cases.

First-year growth trajectory and early nutritional requirements for optimal growth in infants with congenital diaphragmatic hernia: a retrospective cohort study

“…The WGV catch-up started from 3 months onwards. These observations are consistent with the study by Terui et al , in which it became positive at 2 months in a similar population 23…”

“…The WGV was negative between birth and discharge, reflecting the physiological weight loss after birth and heavy resuscitation care. This is especially true during the acute phase and the perioperative period, when fluid restriction is required and aggressive parenteral nutrition is limited because of its potential negative consequences due to metabolic stress 8 23. The WGV catch-up started from 3 months onwards.…”

“…Based on calorimetric studies, Haliburton et al found that a mean caloric intake of 125±20 kcal/kg/day was required to achieve a weight gain of 25–35 g/kg/day 14 28. In the study by Terui et al , the caloric needs to achieve positive WGV at 2 months were estimated to be at least 122 kcal/kg/day in severe cases and 115 kcal/kg/day in others 23. Tailored diet fortification to increase caloric density while reducing volume is therefore an important strategy to limit GF.…”

Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative

“…Studies continue to deepen our understanding of the long-term sequelae of CDH beyond the initial NICU admission along a number of biophysical domains, including cardiopulmonary,124–131 gastrointestinal/nutrition/growth,127 132–136 neurodevelopmental,126 128 132 137–140 musculoskeletal128 141 and all-cause late mortality 142. These findings reinforce the importance of longitudinal follow-up by a team with CDH-specific expertise in accordance with the American Academy of Pediatrics guidelines.…”

Risk factors for and developmental relation of delayed oral nutrition in infants with congenital diaphragmatic hernia

“…Important practices about nutritional management after diaphragmatic repair in CDH include repeating nutritional assessments until adequate weight gain is ensured and increasing nutritional intake until then, even with highconcentration milk or tube feeding. [31,32]. These amounts are higher than the nutritional requirements of infants without diseases and will require early nutritional team support in the postoperative period.…”