Short-term weight gain velocity in infants with congenital diaphragmatic hernia (CDH).
Appropriate post-natal growth remains a mainstay of therapeutic goals for infants with CDH, with the hypothesis that optimizing linear growth will improve survival through functional improvements in pulmonary hypoplasia. However, descriptions of growth and the effect on survival are limited in affected infants.



Describe in-hospital weight gain related to survival among infants with CDH.



Children's Hospitals Neonatal Database (CHND) identified infants with CDH born ≥34weeks' gestation (2010-14). Exclusion criteria were: admission age>7days, death/discharge age<14days, or surgical CDH repair prior to admission. Weight gain velocity (WGV: g/kg/day) was calculated using an established exponential approximation and the cohort stratified by Q1: <25%ile, Q2-3: 25-75%ile, and Q4: >75%ile. Descriptive measures and unadjusted Kaplan-Meier analyses describe the implications of WGV on mortality/discharge.



In 630 eligible infants, median WGV was 4.6g/kg/day. After stratification by WGV [Q1: (n=156; <3.1g/kg/day); Q2-3 (n=316; 3.1-5.9g/kg/day), and Q4 (n=158, >5.9g/kg/day)] infants in Q1 had shortest median length of stay, less time on TPN and intervention for gastro-esophageal reflux relative to the other WGV strata (p<0.01 for all). Unadjusted survival estimates revealed that Q1 [hazard ratio (HR)=9.5, 95% CI: 5.7, 15.8] and Q4 [HR=2.9, 95% CI: 1.7, 5.1, p<0.001 for both] WGV were strongly associated with NICU mortality relative to Q2-3 WGV.



Variable WGV is evident in infants with CDH. Highest and lowest WGV appear to be related to adverse outcomes. Efforts are needed to develop nutritional strategies targeting optimal growth.
Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, United States.
Jason
J
Gien
Ann and Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Karna
K
Murthy
Children's Mercy Hospital and University of Missouri, Kansas City, MO, United States.
Eugenia K
EK
Pallotto
Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Beverly
B
Brozanski
Nationwide Children's Hospital, Columbus, OH, United States.
Louis
L
Chicoine
Children's Hospital Association, Overland Park, KS, United States.
Isabella
I
Zaniletti
Nationwide Children's Hospital, Columbus, OH, United States.
Ruth
R
Seabrook
Children's Healthcare of Atlanta at Egleston, Atlanta, GA, United States.
Sarah
S
Keene
Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, United States.
Deepthi
D
Alapati
Ann and Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Nicolas
N
Porta
Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
Natalie
N
Rintoul
Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, United States. Electronic address: theresa.grover@childrenscolorado.org.
Theresa R
TR
Grover
D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016019:Survival Analysis; D015430:Weight Gain
Congenital diaphragmatic hernia; NICU; Neonatal growth; Neonatal nutrition; Neonatology; Pulmonary hypertension; Pulmonary hypoplasia; Respiratory failure