Predictors of Low Weight and Tube Feedings in Children With Congenital Diaphragmatic Hernia at 1 Year of Age

Pierog, Anne; Aspelund, Gudrun; Farkouh-Karoleski, Christiana; Wu, Mengfei; Kriger, Joshua; Wynn, Julia; Krishnan, Usha; Mencin, Ali

doi:10.1097/mpg.0000000000000454

Cited by 31 publications

(30 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regardless of timing of diagnosis, CDH has a high incidence of pulmonary comorbidities and interventions. These included ECMO use, mechanical ventilation, and treatment for pulmonary arterial hypertension, which have been shown in other studies of various neonatal intensive care unit populations to be associated with likelihood of G-tube placement [9,10]. …”

Section: Discussionmentioning

confidence: 99%

Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes

Rudra

Adibe

Malcolm

et al. 2016

Early Human Development

View full text Add to dashboard Cite

Background Gastrostomy tube (G-tube) placement is a common intervention for newborns with severe feeding difficulties. Infants with congenital diaphragmatic hernia (CDH) are at high risk for feeding problems. Prevalence of G-tube placement and consequent nutritional outcomes of infants with CDH and G-tubes has not been described. Aims Determine factors associated with G-tube placement and growth in infants with congenital diaphragmatic hernia. Study design Retrospective cohort study of infants with CDH to evaluate the association of G-tube placement with risk factors using logistic regression. We also assessed the association between growth velocity and G-tube placement and other risk factors using linear regression. Subjects The subjects of the study were infants with CDH treated at Duke University Medical Center from1997 to 2013. Outcome measures Weight gain in infants with CDH that had G-tube placement compared to those infants with CDH that did not. Result Of the 123 infants with CDH, 85 (69%) survived and G-tubes were placed in 25/85 (29%) survivors. On adjusted analysis, extracorporeal membrane oxygenation (OR=11.26 [95% CI: 1.92–65.89]; P=0.01) and proton pump inhibitor use (OR=17.29 [3.98–75.14], P ≤0.001) were associated with G-tube placement. Infants without G-tubes had a growth velocity of 6.5 g/day (95% CI: 2.5–10.4) more than infants with G-tubes. Conclusion Survivors with more complex inpatient courses were more likely to receive G-tubes. Further investigation is needed to identify optimal feeding practices for infants with CDH.

show abstract

Section: Discussionmentioning

confidence: 99%

Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes

Rudra

Adibe

Malcolm

et al. 2016

Early Human Development

View full text Add to dashboard Cite

show abstract

“…A history of FETO intervention was a significant risk factor for FFT but not in the multivariate analysis. In a large series involving CDH survivors, 35% of the children had a weight below the 5th percentile at 1 year despite the fact that 18% were still being tube-fed [9]. Another series reported better weight z scores 12 months after paediatric ICU discharge [16], but taking into account the lower need for patch repair (50%), they likely included a lower-risk group.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective studies on CDH survivors have reported a high long-term morbidity, including high incidences of gastro-oesophageal reflux disease (GERD), a “failure to thrive” (FTT), chronic lung disease, and pulmonary hypertension (PHT) [2,8,9]. Prospective data on the long-term outcome in CDH survivors, in particular those treated with foetal therapy, is lacking.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention

Ginderdeuren

Allegaert²,

Decaluwé³

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Congenital diaphragmatic hernia (CDH) is an abnormal development of the diaphragm leading to high neonatal mortality and morbidity. Beyond the neonatal period, prospective data on overall long-term outcome in CDH survivors is scarce. In particular, for those treated with fetoscopic endoluminal tracheal occlusion (FETO), a promising new technique to increase survival chances for severe cases, the outcomes are even less documented. Aim: To prospectively document the clinical outcome of CDH at 1 year including FETO-treated infants in relation to ante- and postnatal variables. Methods: A single-centre prospective clinical follow-up at 1 year of age included a standardised respiratory questionnaire. Results: Thirty-four CDH survivors were included, 10 of which were FETO-treated infants. At 1 year, the median weight z score was -1.50 (interquartile range [IQR]: -2.45 to -0.88) and 10/34 were “failure to thrive” (FTT) cases. Gastro-intestinal (GI) problems at 1 year were mainly related to gastro-oesophageal reflux (16/34) with a high need for tube feeding in the first year (9/34). Tachypnoea was present in 10/29 (34%) and 8/34 (24%) were on chronic inhaled medication. The median total respiratory symptom score was 20 (IQR: 13-32) and correlated with the number of neonatal ventilation days (p = 0.048). Hospital re-admission occurred in 19/34 infants (56%), and was for respiratory problems in almost half of them (8/19). Conclusion: In this CDH cohort, morbidity at 1 year was determined more by GI problems and FTT than respiratory morbidity. The respiratory questionnaire may, however, have underestimated the respiratory morbidity since respondents had a 1-in-4 chance to have persistent tachypnoea and be on chronic inhalation therapy.

show abstract

“…Neonates following discharge should achieve normal weight and height for age. Unfortunately, many neonatal ECLS survivors (in some series up to 35%) have head circumference < 5% at 1 year of age . Whether this is a result of nutrition deficits or secondary to underlying disease is unclear, but effort should be made to ensure nutrition is optimized for appropriate growth.…”

Section: Long‐term Nutrition Considerationsmentioning

confidence: 99%

“…Infants who have a history of congenital diaphragmatic hernia (CDH) are at particularly high risk for nutrition problems after discharge, especially during the first year of life . Growth failure, poor oral feeding, and need for gastrostomy tube placement are common and well documented in the literature.…”

Section: Long‐term Nutrition Considerationsmentioning

confidence: 99%

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

2018

View full text Add to dashboard Cite

Critically ill neonates who require extracorporeal life support have particular nutrition needs. These infants require prescription of aggressive, early nutrition support by knowledge providers. Understanding the unique metabolic demands and nutrition requirements of these fragile patients is paramount, particularly if additional therapies such as aggressive diuretic regimens or continuous renal replacement therapy are used concurrently. Although the American Society for Parenteral and Enteral Nutrition has published guidelines for this population, a review of each nutrition component is warranted because few studies exist specific to this population. Long-term complications in survivors of neonatal extracorporeal life support, particularly in patients with select diagnoses such as congenital diaphragmatic hernia, can be significant and must be recognized and anticipated. This review focuses on recognizing the nutrition needs of neonatal patients requiring extracorporeal life support, appraising the available data to guide selection of an appropriate mode of nutrition delivery, and describing the anticipated long-term nutrition implications of extracorporeal life support provision during the neonatal period.

show abstract

Predictors of Low Weight and Tube Feedings in Children With Congenital Diaphragmatic Hernia at 1 Year of Age

Cited by 31 publications

References 11 publications

Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes

Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes

Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

Contact Info

Product

Resources

About