Haliburton Beth, Chiang Monping, Marcon Margaret, Moraes Theo J, Chiu Priscilla P, Mouzaki Marialena
*Department of Surgery, Department of Clinical Dietetics, Division of Pediatric General and Thoracic Surgery †Department of Surgery, Division of General and Thoracic Surgery ‡Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition §Department of Pediatrics, Division of Respiratory Medicine ||Department of Surgery. Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
J Pediatr Gastroenterol Nutr. 2016 Mar;62(3):474-8. doi: 10.1097/MPG.0000000000001000.
BACKGROUND/OBJECTIVES: The pathophysiology of failure to thrive in congenital diaphragmatic hernia (CDH) has not been fully elucidated, and the nutritional care of these infants is hindered by paucity of data on the optimal calorie requirements for growth. The primary objective of this study was to investigate the energy intake required for infants with CDH to grow optimally at the time of first hospital discharge. The secondary objectives were to assess their measured resting energy expenditure in infancy, and their long-term growth outcomes.
Nutritional intake, anthropometrics, indirect calorimetry results, and respiratory status of infants with CDH from 2011 to 2014 were collected retrospectively. Data on confounders (gastroesophageal reflux disease and feeding intolerance, respiratory rate and pulmonary hypertension) were also collected. Analyses were performed using Stata (College Station, TX).
Of the 72 infants diagnosed with CDH during that period of time, 43 met the inclusion criteria. A caloric intake of 125.0 ± 20 kcal · kg · day was required to meet discharge weight gain criteria (25-35 g · kg · day). In a subset of 17 patients, measured resting energy expenditure was higher than predicted resting energy expenditure (58.0 ± 18 vs 46.6 ± 3 kcal · kg · day, P < 0.05), and 59% of infants were hypermetabolic (measured resting energy expenditure >110% of predicted resting energy expenditure) in early infancy. Failure to thrive prevalence at discharge was 16.2% compared to 3.6% and 4.2% at 12- and 24-months of age, respectively (P = 0.03; P = 0.005, respectively).
Optimal weight gain can be achieved with higher than predicted calorie provision. Most infants with CDH are hypermetabolic. Despite this, failure to thrive prevalence can improve during the first year of life.
背景/目的：先天性膈疝（CDH）患儿生长发育迟缓的病理生理学机制尚未完全阐明，由于缺乏关于最佳生长所需热量需求的数据，这些婴儿的营养护理受到阻碍。本研究的主要目的是调查CDH患儿首次出院时实现最佳生长所需的能量摄入。次要目的是评估其婴儿期测得的静息能量消耗以及长期生长结局。
回顾性收集2011年至2014年CDH患儿的营养摄入、人体测量学数据、间接测热法结果及呼吸状况。还收集了混杂因素（胃食管反流病和喂养不耐受、呼吸频率和肺动脉高压）的数据。使用Stata（德克萨斯州大学站）进行分析。
在那段时间诊断出的72例CDH患儿中，43例符合纳入标准。达到出院体重增加标准（25 - 35 g·kg·天）需要摄入125.0±20 kcal·kg·天的热量。在17例患者的亚组中，测得的静息能量消耗高于预测的静息能量消耗（58.0±18 vs 46.6±3 kcal·kg·天，P<0.05），59%的婴儿在婴儿早期处于高代谢状态（测得的静息能量消耗>预测静息能量消耗的110%）。出院时生长发育迟缓的患病率为16.2%，而在12个月和24个月龄时分别为3.6%和4.2%（P = 0.03；P = 0.005）。
提供高于预测的热量可实现最佳体重增加。大多数CDH患儿处于高代谢状态。尽管如此，生长发育迟缓的患病率在生命的第一年可有所改善。
