Congenital Diaphragmatic Hernia and Growth to 12 Years

Abstract

OBJECTIVES: Growth problems are reported in patients with congenital diaphragmatic hernia during the first years of life. However, it is unknown if poor growth persists during childhood. We therefore evaluated growth of patients longitudinally until 12 years of age. METHODS: This prospective study included 172 patients (43 treated with extracorporeal membrane oxygenation [ECMO]) born from 1999 to 2014. Z scores of height-for-age (HFA), weight-for-height, and distance-to-target height were calculated at 6 months of age and at 1, 2, 5, 8, and 12 years of age. Data were analyzed by using general linear models. RESULTS: At 1 year of age, the mean weight-for-height z score had declined in ECMO (−1.30, 95% confidence interval: −1.62 to −0.97) and non-ECMO patients (−0.72, 95% confidence interval: −0.91 to −0.54; P < .05). Thereafter in ECMO patients, the mean HFA z score deteriorated between 1 (−0.43, 95% confidence interval: −0.73 to −0.13) and 5 years of age (−1.08, 95% confidence interval: −1.38 to −0.78; P < .01). In non-ECMO patients, the mean HFA z score deteriorated between 2 (−0.35, 95% confidence interval: −0.53 to −0.17) and 5 years of age (−0.56, 95% confidence interval: −0.75 to −0.37; P = .002). At 12 years of age, the mean HFA z score was still less than the norm in both groups: ECMO (−0.67, 95% confidence interval: −1.01 to −0.33) versus non-ECMO (−0.49, 95% confidence interval: −0.77 to −0.20; P < .01). Adjusting for target height improved the mean height z scores but did not bring them to normal range. CONCLUSIONS: Poor linear growth persisted at 12 years of age. The pattern of early deterioration of weight gain followed by a decline in linear growth is suggestive of inadequate nutrition during infancy. Therefore, nutritional assessment and intervention should be started early and should be continued during childhood.