TY - JOUR
T1 - Short-term weight gain velocity in infants with congenital diaphragmatic hernia (CDH)
AU - Gien, Jason
AU - Murthy, Karna
AU - Pallotto, Eugenia K.
AU - Brozanski, Beverly
AU - Chicoine, Louis
AU - Zaniletti, Isabella
AU - Seabrook, Ruth
AU - Keene, Sarah
AU - Alapati, Deepthi
AU - Porta, Nicolas
AU - Rintoul, Natalie
AU - Grover, Theresa R.
AU - Children's Hospitals Neonatal Consortium CDH Study Group
N1 - Publisher Copyright:
© 2017
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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.
AB - 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.
KW - Congenital diaphragmatic hernia
KW - NICU
KW - Neonatal growth
KW - Neonatal nutrition
KW - Neonatology
KW - Pulmonary hypertension
KW - Pulmonary hypoplasia
KW - Respiratory failure
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U2 - 10.1016/j.earlhumdev.2017.01.010
DO - 10.1016/j.earlhumdev.2017.01.010
M3 - Article
C2 - 28178582
AN - SCOPUS:85011684800
SN - 0378-3782
VL - 106-107
SP - 7
EP - 12
JO - Early Human Development
JF - Early Human Development
ER -