Impact of nutrition in the treatment of congenital diaphragmatic hernia

Abstract

Background The optimum enteral (EN) and parenteral nutrition (PN) regimens during acute management of congenital diaphragmatic hernia (CDH) remain unclear. We examined the effects of EN and PN on weight gain in CDH patients. Methods A multicenter retrospective cohort study of neonates with CDH (born 2006–2010; n = 105) who survived to discharge was conducted. Patients were divided as receiving PN ≥ or <50 kcal/kg/day at 1 week of age, and EN ≥ or <60 kcal/kg/day at 2 weeks of age. Changes in bodyweight at 30, 60, and 90 days of age were compared. Results The higher EN group (n = 39) had greater mean weight gain than the 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 EN, the higher PN group (n = 24) had greater mean weight gain than the lower PN group (n = 42; 90 days: 1,768 g, 95% CI: 1,574–1,961 g vs 1,411 g, 95% CI: 1,264–1,558 g; P = 0.004). Conclusion 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.

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

“…GER, oral aversion, and allergies can also contribute to difficulties in enteral feeding [14,15]. We previously reported that EN and supportive PN in the acute phase were essential for weight gain during infancy [16]. Furthermore, increase in the energy requirement may be an underestimated factor [17].…”

Nutrition Interventions Associated With Favorable Growth in Infants With Congenital Diaphragmatic Hernia

“…In a multicenter study of 105 infants in Japan, Terui et al found that those who received ≥50 kcal/kg/d PN during the first week of life had significantly higher weight at age 60 and 90 days than those with <50 kcal/kg/d PN (60 days, 1.06 kg vs 0.71 kg [P = 0.006]; 90 days, 1.76 kg vs 1.41 kg [P = 0.004]). 13 One goal of nutrition support is to transition from PN to EN when appropriate, and the authors also analyzed the effect of EN in the second week of life. Similar to the results in their PN analysis, infants who received ≥60 kcal/kg/d EN by week 2 had significantly higher weight, by 23.4% and 22.5%, respectively, at 60 and 90 days than those with intake <60 kcal/kg/d (60 days, 4.31 kg vs 3.49 kg [P < 0.001]; 90 days, 5.16 kg vs 4.21 kg [P < 0.001]).…”

“…16 When preoperative feeding is not tenable, enteral nutrition (EN) should be introduced when bowel function, after surgical manipulation, returns. However, infants are often perceived to experience intolerance, which may be attributable to GER, 8 inconsistent intestinal motility related to analgesic medications, 13 or uncommonly, structural abnormalities within the gastrointestinal tract. 17 Some practitioners suggest aggressive strategies for managing GER, including medication, surgery, and feeding tube (FT) use, 16,17 whereas others point out that most infants will exhibit GER symptoms because of their liquid diet and postprandial supine positioning.…”

Importance of nutrition strategy in infants with congenital diaphragmatic hernia

“…Terui et al . recently published the article, “Impact of nutrition in the treatment of congenital diaphragmatic hernia” in Pediatrics International . The conclusions of that article were as follows: the amount of enteral and parental nutrition is essential for weight gain during infancy in the acute phase of CDH management; an aggressive enteral nutrition strategy is recommended; and when CDH patients do not tolerate enteral nutrition, supportive parental nutrition is essential.…”

“…In the nationwide, multicenter, retrospective observational study of neonatal CDH conducted by the Japanese Congenital Diaphragmatic Hernia Study Group reported by Terui et al . in this issue, the main message is that nutrition management is important for adequate bodyweight gain in infants with CDH . Although physical growth is an important issue in children, further research is required to establish an optimal nutritional strategy in order to improve neurodevelopmental outcomes.…”