Predictors of Low Weight and Tube Feedings in Children With Congenital Diaphragmatic Hernia at 1 Year of Age

Objectives: Congenital diaphragmatic hernia (CDH) survivors often have gastrointestinal disorders, and limited outcome data exist. This study reviewed risk factors for low weight and use of feeding tubes after CDH repair at 1 year of age. The hypothesis was that patients who required extracorporeal membrane oxygenation (ECMO) or with significant pulmonary arterial hypertension (PAN) would have lower weight percentiles and more often require tube feedings. Methods: A retrospective chart review of 89 infants with CDH diagnosed in the neonatal period was conducted. Statistical analysis was performed using chi(2) test, Fisher exact test, and logistic regression. Results: Seventy-two patients (81%) survived to 1 year of age. Of these patients, 35% were <5th percentile for weight and 18% were receiving tube feedings. Both ECMO and PAN were associated with an increased risk for requiring tube feedings at 1 year of age, with respective odds ratios of 6.00 (P=0.01) and 15.75 (P=0.02); however, neither ECMO nor PAH was associated with low weight at 1 year of age. No statistical correlation was found between an abnormal pH probe and tube feedings at 1 year of age. Conclusions: Patients with CDH are at increased risk for having a weight <5th percentile at 1 year of age. A history of ECM() and PAN are independently associated with an increased requirement for tube feedings at 1 year of age. Close nutritional monitoring and counseling should be considered in all of the patients with CDH, particularly those with a history of ECMO or PAN.