Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Eur J Pediatr Surg. 2023 Dec;33(6):469-476. doi: 10.1055/s-0043-1767829. Epub 2023 Mar 16.
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.
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.
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.
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.
在先天性膈疝（CDH）新生儿和术后期间，营养支持具有挑战性且存在争议。本研究旨在报告 CDH 患儿在围手术期出现症状时的早期肠内营养支持，包括可行性、与建立完全肠内营养相关的因素，以及出生体重、出院体重和 18 个月体重。
我们回顾性收集了营养方面的数据：肠内营养的类型和量以及父母的支持。肠内喂养从出生后第 1 天开始，逐步增加（首选母乳），并在 CDH 修复后于术后第 1 天恢复。基线数据来自我们的 CDH 数据库。
2011 年至 2020 年，我们共纳入 45 例 CDH 患儿。其中女孩 22 例（51.1%），左侧 35 例（77.8%），40 例行 CDH 修复术（88.9%）。患儿在儿科重症监护病房的中位（四分位间距）住院时间为 14.6 天（6.0-26.5），1 年死亡率为 17.8%。术后，中位时间为 6.5（3.6-12.6）和 10.6（7.6-21.7）天时，患儿分别实现了 120 和 160mL/kg/d 的肠内营养。总共 31 例（68.9%）患儿需要在中位时间为 8 天（5-18 天）时补充肠外营养，其中 11 例在 CDH 修复前开始肠外营养。未报告与肠内喂养相关的并发症。
CDH 患儿早期肠内营养是可行的，可能减少对肠外营养的需求，并减少术后达到完全肠内营养的时间。
