Nutritional Intake, Energy Expenditure, and Growth of Infants Following Congenital Diaphragmatic Hernia Repair

Background/ Objectives: The pathophysiology of failure to thrive in congenital diaphragmatic hernia ( CDH) has not been fully elucidated, and the nutritional care of these infants is hindered by paucity of data on the optimal calorie requirements for growth. The primary objective of this study was to investigate the energy intake required for infants with CDH to grow optimally at the time of first hospital discharge. The secondary objectives were to assess their measured resting energy expenditure in infancy, and their long-term growth outcomes. Methods: Nutritional intake, anthropometrics, indirect calorimetry results, and respiratory status of infants with CDH from 2011 to 2014 were collected retrospectively. Data on confounders ( gastroesophageal reflux disease and feeding intolerance, respiratory rate and pulmonary hypertension) were also collected. Analyses were performed using Stata ( College Station, TX). Results: Of the 72 infants diagnosed with CDH during that period of time, 43 met the inclusion criteria. A caloric intake of 125.0 +/- 20 kcal kg(-1) day(-1) was required to meet discharge weight gain criteria ( 25-35 g kg(-1) day(-1)). In a subset of 17 patients, measured resting energy expenditure was higher than predicted resting energy expenditure ( 58.0 +/- 18 vs 46.6 +/- 3 kcal kg-1 day-1, P< 0.05), and 59% of infants were hypermetabolic ( measured resting energy expenditure > 110% of predicted resting energy expenditure) in early infancy. Failure to thrive prevalence at discharge was 16.2% compared to 3.6% and 4.2% at 12- and 24- months of age, respectively ( P - 0.03; P = 0.005, respectively). Conclusions: Optimal weight gain can be achieved with higher than predicted calorie provision. Most infants with CDH are hypermetabolic. Despite this, failure to thrive prevalence can improve during the first year of life.