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Eur J Pediatr Surg 2023; 33(06): 469-476
DOI: 10.1055/s-0043-1767829
Original Article

Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia

Ulla Lei Larsen 
1   Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
2   Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
,
Gitte Zachariassen
2   Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
3   H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
,
Sören Möller
2   Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
,
Wilhelmine Ursin Førre
1   Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
,
Ingvild Grøsle
1   Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
,
Susanne Halken
3   H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
,
Anne Maria Herskind
3   H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
,
Thomas Strøm
1   Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
4   Department of Anaesthesiology and Intensive Care, Hospital Sønderjylland, University of Southern Denmark, Odense, Denmark
,
Palle Toft
1   Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
,
Mark Ellebæk
5   Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
6   Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
,
Niels Qvist
2   Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
5   Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
6   Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
› Author Affiliations Funding This work was supported by Børnelungefonden, DASAIMs forsknings initiative, OUHs overlægeråds forskningsfond, 53-A2591, Research Council of the Region of Southern Denmark, 18/17564.
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Abstract

Objectives Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months.

Methods We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database.

Results From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0–26.5), and 1-year mortality was 17.8%.

Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6–12.6) and 10.6 (7.6–21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5–18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported.

Conclusion Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.

Keywords

congenital diaphragmatic hernia - enteral nutrition - preoperative period - infants - PICU


Publication History

Received: 01 July 2022

Accepted: 04 November 2022

Article published online:
16 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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