Short-term weight gain velocity in infants with congenital diaphragmatic hernia (CDH)

Jason Gien, Karna Murthy, Eugenia K. Pallotto, Beverly Brozanski, Louis Chicoine, Isabella Zaniletti, Ruth Seabrook, Sarah Keene, Deepthi Alapati, Nicolas Porta, Natalie Rintoul, Theresa R. Grover*, Children's Hospitals Neonatal Consortium CDH Study Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background Appropriate post-natal growth remains a mainstay of therapeutic goals for infants with CDH, with the hypothesis that optimizing linear growth will improve survival through functional improvements in pulmonary hypoplasia. However, descriptions of growth and the effect on survival are limited in affected infants. Objective Describe in-hospital weight gain related to survival among infants with CDH. Design/methods Children's Hospitals Neonatal Database (CHND) identified infants with CDH born ≥ 34 weeks’ gestation (2010–14). Exclusion criteria were: admission age > 7 days, death/discharge age < 14 days, or surgical CDH repair prior to admission. Weight gain velocity (WGV: g/kg/day) was calculated using an established exponential approximation and the cohort stratified by Q1: < 25%ile, Q2–3: 25–75%ile, and Q4: > 75%ile. Descriptive measures and unadjusted Kaplan-Meier analyses describe the implications of WGV on mortality/discharge. Results In 630 eligible infants, median WGV was 4.6 g/kg/day. After stratification by WGV [Q1: (n = 156; < 3.1 g/kg/day); Q2–3 (n = 316; 3.1–5.9 g/kg/day), and Q4 (n = 158, > 5.9 g/kg/day)] infants in Q1 had shortest median length of stay, less time on TPN and intervention for gastro-esophageal reflux relative to the other WGV strata (p < 0.01 for all). Unadjusted survival estimates revealed that Q1 [hazard ratio (HR) = 9.5, 95% CI: 5.7, 15.8] and Q4 [HR = 2.9, 95% CI: 1.7, 5.1, p < 0.001 for both] WGV were strongly associated with NICU mortality relative to Q2–3 WGV. Conclusion Variable WGV is evident in infants with CDH. Highest and lowest WGV appear to be related to adverse outcomes. Efforts are needed to develop nutritional strategies targeting optimal growth.

Original languageEnglish (US)
Pages (from-to)7-12
Number of pages6
JournalEarly Human Development
Volume106-107
DOIs
StatePublished - Mar 1 2017

Keywords

  • Congenital diaphragmatic hernia
  • NICU
  • Neonatal growth
  • Neonatal nutrition
  • Neonatology
  • Pulmonary hypertension
  • Pulmonary hypoplasia
  • Respiratory failure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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