Impact of nutrition in the treatment of congenital diaphragmatic hernia

Background The optimum enteral ( EN ) and parenteral nutrition ( PN ) regimens during acute management of congenital diaphragmatic hernia ( CDH ) remain unclear. We examined the effects of EN and PN on weight gain in CDH patients. Methods A multicenter retrospective cohort study of neonates with CDH (born 2006–2010; n = 105) who survived to discharge was conducted. Patients were divided as receiving PN ≥ or <50 kcal/kg/day at 1 week of age, and EN ≥ or <60 kcal/kg/day at 2 weeks of age. Changes in bodyweight at 30, 60, and 90 days of age were compared. Results The higher EN group ( n = 39) had greater mean weight gain than the lower EN group ( n = 66; 90 days: 2,501 g, 95% CI : 2,294–2,710 g vs 1,706 g, 95% CI : 1,553–1,861 g; P <0.001). When patients received lower EN , the higher PN group ( n = 24) had greater mean weight gain than the lower PN group ( n = 42; 90 days: 1,768 g, 95% CI : 1,574–1,961 g vs 1,411 g, 95% CI : 1,264–1,558 g; P = 0.004). Conclusion The amount of EN in the acute phase of CDH management is essential for weight gain during infancy. When patients are intolerant to adequate EN , supportive PN is also essential.