Growth impairment persists in kids with congenital diaphragmatic hernia

Last Updated: 2017-07-14

By Reuters Staff

NEW YORK (Reuters Health) - Poor growth during the first years of life in children with congenital diaphragmatic hernia (CDH) is likely to persist into adolescence, according to results of a prospective longitudinal study.

In a report online today in Pediatrics, Dr. Hanneke IJsselstijn and colleagues from Erasmus Medical Center, Rotterdam, the Netherlands, say the growth pattern they observed - early deterioration of weight gain followed by a decline in linear growth - is suggestive of inadequate nutritional intake to meet energy needs during infancy. Therefore, they recommend nutritional assessment and intervention should start early and continue during childhood in children with CDH.

The study included 172 children (57% male) born from 1999 to 2014. Forty-three children (25%) received extracorporeal membrane oxygenation (ECMO). The researchers evaluated several growth parameters at age six months and again at age one, two, five, eight and 12 years.

At one year of age, the mean weight-for-height z score had declined in ECMO (-1.30) and non-ECMO (-0.72) patients (P<0.05).

Between one and two years of age, z score of height-for-age (HFA) deteriorated in ECMO patients (-0.43 and -1.08; P<0.01). In non-ECMO patients, mean HFA z score deteriorated between ages two and five (-0.35 and -0.56; P=0.002).

At age 12, the mean HFA z score was still less than the norm in both groups: -0.67 with ECMO and -0.49 without ECMO (P<0.01). “Adjusting for target height improved the mean height z scores but did not bring them to normal range,” the researchers report.

Early growth problems are an important issue in patients with CDH, they note, and this study demonstrates that these children are at risk for impaired growth in the long-term, especially those treated with neonatal ECMO.

They say multiple factors are likely involved, including feeding problems and increased metabolism due to the increased work of breathing.

“This study shows the importance for early risk stratification for poor growth to identify patients at a high risk, such as those who required ECMO treatment,” the researchers conclude in their paper. “Early risk stratification should be combined with nutritional assessments and interventions, as well as long-term follow-up of growth. Further studies are needed to determine the relation between growth problems and functional outcomes, both physical and neuropsychological.”

Dr IJsselstijn did not respond to a request for comment by press time.

SOURCE: http://bit.ly/2tmD2FW

Pediatrics 2017.