Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence

Beth Haliburton; Marialena Mouzaki; Monping Chiang; Vikki Scaini; Margaret Marcon; Theo J Moraes; Priscilla P Chiu

doi:10.1016/j.jpedsurg.2015.02.026

Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence

J Pediatr Surg. 2015 May;50(5):734-8. doi: 10.1016/j.jpedsurg.2015.02.026. Epub 2015 Feb 20.

Authors

Beth Haliburton¹, Marialena Mouzaki², Monping Chiang³, Vikki Scaini⁴, Margaret Marcon⁵, Theo J Moraes⁶, Priscilla P Chiu⁷

Affiliations

¹ Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: beth.haliburton@sickkids.ca.
² Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: marialena.mouzaki@sickkids.ca.
³ Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: monping.chaing@sickkids.ca.
⁴ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: Vikki.scaini@sickkids.ca.
⁵ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: peggy.marcon@sickkids.ca.
⁶ Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: theo.moreas@sickkids.ca.
⁷ Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: priscilla.chiu@sickkids.ca.

PMID: 25783378
DOI: 10.1016/j.jpedsurg.2015.02.026

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.

Keywords: Calorimetry; Congenital diaphragmatic hernia; Enteral feeding tubes; Failure to thrive; Nutritional morbidity.

MeSH terms

Adolescent
Child
Child, Preschool
Failure to Thrive / epidemiology*
Failure to Thrive / etiology
Female
Follow-Up Studies
Hernias, Diaphragmatic, Congenital / complications*
Humans
Incidence
Male
Morbidity / trends
Ontario / epidemiology
Retrospective Studies
Survivors
Time Factors