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

Terui, Keita; Tazuke, Yuko; Nagata, Kouji; Ito, Miharu; Okuyama, Hiroomi; Hayakawa, Masahiro; Taguchi, Tomoaki; Sato, Yasunori; Usui, Noriaki

PURPOSE: Growth retardation is a severe morbidity in infants with congenital diaphragmatic hernia (CDH). This study aimed to determine when catch-up growth starts in infants with CDH and to determine the adequate amount of nutrition required during catch-up growth. METHODS: This was a multicenter retrospective cohort study involving neonates with isolated CDH (born 2006–2010; n = 98). Weight gain velocity (WGV) was calculated using body weight Z-scores. The minimum required weight gain was defined as WGV ≥ 0. Patients were dichotomized into severe and non-severe cases according to diaphragmatic defects. RESULTS: Average monthly WGV changed from < 0 to ≥ 0 at 2 months of age. Total caloric intake at 2 months of age was lower when the WGV between 1 and 3 months was < 0 in both severe cases [122 (95% confidence interval (CI) 116–128) vs. 97 (95% CI 84–110) kcal/kg/day, p = 0.02] and non-severe cases [115 (95% CI 110–120) vs. 99 (95% CI 87–111) kcal/kg/day, p < 0.001)]. CONCLUSION: Catch-up growth started at approximately 2 months of age. During this period, total caloric intake of > 122 kcal/kg/day was needed to avoid decreases in the body weight Z-score in severe cases.