A clinical consensus guideline for nutrition in infants with congenital diaphragmatic hernia from birth through discharge

Patrick Sloan; Sandy Johng; John M Daniel; Christopher J Rhee; Burhan Mahmood; Evangelia Gravari; Susan Marshall; Ann G Downey; Katie Braski; Sharada H Gowda; Caraciolo J Fernandes; Vedanta Dariya; Beth E Haberman; Ruth Seabrook; Abhishek Makkar; Brian W Gray; Michael W Cookson; Tasnim Najaf; Natalie Rintoul; Holly L Hedrick; Robert DiGeronimo; Mark F Weems; Anne Ades; Rachel Chapman; Theresa R Grover; Sarah Keene

doi:10.1038/s41372-024-01965-9

A clinical consensus guideline for nutrition in infants with congenital diaphragmatic hernia from birth through discharge

J Perinatol. 2024 Apr 16. doi: 10.1038/s41372-024-01965-9. Online ahead of print.

Authors

Patrick Sloan¹, Sandy Johng², John M Daniel³, Christopher J Rhee⁴, Burhan Mahmood⁵, Evangelia Gravari⁶, Susan Marshall⁷, Ann G Downey⁶, Katie Braski⁶, Sharada H Gowda⁴, Caraciolo J Fernandes⁴, Vedanta Dariya⁸, Beth E Haberman⁹, Ruth Seabrook¹⁰, Abhishek Makkar⁸, Brian W Gray¹¹, Michael W Cookson¹², Tasnim Najaf¹³, Natalie Rintoul¹⁴, Holly L Hedrick¹⁵, Robert DiGeronimo², Mark F Weems¹⁶, Anne Ades¹⁴, Rachel Chapman¹⁷, Theresa R Grover¹², Sarah Keene¹⁸

Affiliations

¹ Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110-1093, USA. sloan.patrick@wustl.edu.
² Department of Pediatrics, Division of Neonatology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
³ Department of Pediatrics, Division of Neonatology, University of Missouri Kansas School of Medicine, Kansas City, MO, USA.
⁴ Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
⁵ Department of Pediatrics, Division of Newborn Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁶ Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA.
⁷ Children's Hospital Colorado, Aurora, CO, USA.
⁸ Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁹ Department of Pediatrics, Division of Neonatology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹⁰ Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
¹¹ Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA.
¹² Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
¹³ Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110-1093, USA.
¹⁴ Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
¹⁵ Department of Pediatric General Thoracic and Fetal Surgery Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
¹⁶ Division of Neonatology and Le Bonheur Children's Hospital, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
¹⁷ Department of Pediatrics, USC Keck School of Medicine, Fetal & Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
¹⁸ Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.

PMID: 38627594
DOI: 10.1038/s41372-024-01965-9

Abstract

Objective: To develop a consensus guideline to meet nutritional challenges faced by infants with congenital diaphragmatic hernia (CDH).

Study design: The CDH Focus Group utilized a modified Delphi method to develop these clinical consensus guidelines (CCG). Topic leaders drafted recommendations after literature review and group discussion. Each recommendation was sent to focus group members via a REDCap survey tool, and members scored on a Likert scale of 0-100. A score of > 85 with no more than 25% outliers was designated a priori as demonstrating consensus among the group.

Results: In the first survey 24/25 recommendations received a median score > 90 and after discussion and second round of surveys all 25 recommendations received a median score of 100.

Conclusions: We present a consensus evidence-based framework for managing parenteral and enteral nutrition, somatic growth, gastroesophageal reflux disease, chylothorax, and long-term follow-up of infants with CDH.