Nutritional morbidity in survivors of congenital diaphragmatic hernia

Purpose: The purpose of this report is to detail the nutritional sequelae s een in survivors of congenital diaphragmatic hernia (CDH) followed in a mul tidisciplinary clinic. Methods: Data on 121 surviving CDH patients seen between 1990 and 2000 were collected. Regression analysis was used to determine the impact of factors such as Apgar score, birth weight, extracorporeal membrane oxygenation (EC MO), and patch repair on outcomes associated with nutritional morbidity. Results: There were 100 left and 21 right CDH defects. Mean birth weight an d 5-minute Apgar score were 3.1 kg (+/-0.8) and 6.8(+/-2), respectively. Ex tracorporeal membrane oxygenation was required in 43 (36%) patients and pat ch repair in 39 (32%). A gastrostomy was required in 39 (32%) patients and a fundoplication in 23 (19%) patients. The side of the defect did not affec t the frequency of these procedures. Fifty-six percent of patients were bel ow the 25th percentile for weight during most of their first year. Regressi on analysis found that duration of ventilation (P <.001) and the presence o f a patch repair (P =.03) were independent variables predictive of failure to thrive thereby requiring a gastrostomy tube. Patch repair also was predi ctive of need for subsequent fundoplication caused by gastroesophageal refl ux (P<.001). Twenty-nine patients (24%) had severe oral aversion. Risk fact ors were prolonged ventilation (P =.001) and oxygen requirement at discharg e (P =.015). Two thirds of these patients subsequently improved. Conclusions: Nutritional problems continue to be a source of morbidity for survivors of CDH, particularly in the first year of life. Not surprisingly, patients who had prolonged intubation and prosthetic material at the gastr oesophageal junction fared worse. Despite aggressive nutritional management , 56% of the population remained below the twenty-fifth percentile for weig ht. These data show the need for careful nutritional assessment in all CDH patients, especially those at high risk for malnutrition. J Pediatr Surg 36 :1771-1176. Copyright (C) 2001 by W.B. Saunders Company.