title: Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence.
abstract: BACKGROUND
  Failure to thrive (FTT) is well documented among congenital diaphragmatic hernia (CDH) survivors ≤3years of age, but its etiology, severity, and persistence beyond this age require further elucidation.
  
  
  METHODS
  We conducted a single-center, retrospective study assessing anthropometrics, measured energy expenditure, and feeding tube (FT) use of 5-17 year olds in our multidisciplinary CDH clinic since January 2001. We stratified clinic visits based on age A: 5.0-6.9, B: 7.0-9.9, C: 10.0-14.9, and D: 15-17.9years.
  
  
  RESULTS
  One hundred sixteen patients with 376 outpatient visits were reviewed. Anthropometric z-scores were below zero and did not vary across age cohorts. FTT and growth stunting each occurred in 14% of clinic visits. FTs inserted during infancy occurred in 25% of patients, and 60% remained by age 7years. In cohort A, those with FTs were lighter and shorter than those without (p<0.05) but had similar BMIs. FTT incidence was higher in the FT group (p=0.020), but FTs were present in only 30% of those with FTT. Indirect calorimetry revealed increased energy expenditure in 58% of patients.
  
  
  CONCLUSIONS
  Failure to thrive continues in long-term CDH survivors, FTs may not improve incidence of FTT. Increased energy expenditure may play a role.
authors.affiliation: Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: beth.haliburton@sickkids.ca.
authors.forename: Beth
authors.initials: B
authors.lastname: Haliburton
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: marialena.mouzaki@sickkids.ca.
authors.forename: Marialena
authors.initials: M
authors.lastname: Mouzaki
authors.affiliation: Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: monping.chaing@sickkids.ca.
authors.forename: Monping
authors.initials: M
authors.lastname: Chiang
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: Vikki.scaini@sickkids.ca.
authors.forename: Vikki
authors.initials: V
authors.lastname: Scaini
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: peggy.marcon@sickkids.ca.
authors.forename: Margaret
authors.initials: M
authors.lastname: Marcon
authors.affiliation: Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: theo.moreas@sickkids.ca.
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Moraes
authors.affiliation: Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: priscilla.chiu@sickkids.ca.
authors.forename: Priscilla P
authors.initials: PP
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005183:Failure to Thrive / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors
keywords: Calorimetry; Congenital diaphragmatic hernia; Enteral feeding tubes; Failure to thrive; Nutritional morbidity