title: Nutritional outcomes in survivors of congenital diaphragmatic hernia (CDH)-factors associated with growth at one year.
abstract: BACKGROUND
  Malnutrition is prevalent among congenital diaphragmatic hernia (CDH) survivors. We aimed to describe the nutritional status and factors that impact growth over the 12-months following discharge from the pediatric intensive care unit (PICU) in this cohort.
  
  
  METHODS
  CDH survivors, who were discharged from the PICU from 2000 to 2010 with follow-up of at least 12months, were included. Nutritional intake, anthropometric, and clinical variables were recorded. Multivariable linear regression was used to determine factors associated with weight-for-age Z-scores (WAZ) at 12months.
  
  
  RESULTS
  Data from 110 infants, 67% male, 50% patch repair, were analyzed. Median (IQR) WAZ for the cohort was -1.4 (-2.4 to -0.3) at PICU discharge and -0.4 (-1.3 to 0.2) at 12-months. The percentage of infants with significant malnutrition (WAZ<-2) decreased from 26% to 8.5% (p<0.001). Patch repair (p=0.009), protein intake<2.3g/kg/day (p=0.014), and birth weight (BW)<2.5kg (p<0.001) were associated with lower WAZ at 12-months.
  
  
  CONCLUSIONS
  CDH survivors had a significantly improved nutritional status in the 12-months after PICU discharge. Patch repair, lower BW, and inadequate protein intake were significant predictors of lower WAZ at 12-months. A minimum protein intake in the PICU of 2.3g/kg/day was essential to ensure optimal growth in this cohort.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Division of Gastroenterology and Nutrition, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Katelyn
authors.initials: K
authors.lastname: Ariagno
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Cauley
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Jill
authors.initials: J
authors.lastname: Zalieckas
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Wilson
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.affiliation: Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States; Division of Critical Care Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, United States. Electronic address: nilesh.mehta@childrens.harvard.edu.
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000328:Adult; D001835:Body Weight; D002648:Child; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016014:Linear Models; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D017741:Survivors
chemical_list: D004044:Dietary Proteins
keywords: Congenital diaphragmatic hernia; Growth; Illness-related malnutrition; Nutrition; Protein