Kim Soo Hyun, Park Sung Hyeon, Lee Ha Na, Lee Jungbok, Jeong Jiyoon, Kwon Hyunhee, Jung Euiseok, Namgung Jung-Man, Lee Byong Sop
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics , University of Ulsan College of Medicine, Seoul, Korea.
BMC Pediatr. 2025 Apr 14;25(1):295. doi: 10.1186/s12887-025-05631-7.
Growth retardation (GR) is one of the major morbidities in congenital diaphragmatic hernia (CDH). This study aimed to investigate the prevalence and perinatal risk factors of growth failure in CDH survivors.
We retrospectively reviewed the medical records of isolated CDH patients with gestational age ≥ 35 weeks who survived to 3 years of age. Weight and length(height) were measured at 1 year, 2 and 3 years of age. GR was defined when the Z-score of weight or height was below - 2.0. We analyzed and compared the prenatal and clinical characteristics, including anthropometric data, fetal lung volume measurement, and treatment modalities during initial hospitalization, between the GR group and the non-GR group.
Of the 116 patients with isolated CDH, 86 patients survived to NICU discharge (74.1%). A total of 77 patients who survived 3 years of age with follow-up growth parameters available were included in the study analysis. The rates of GR at 1 year, 2 and 3 years of age was 15.6% (12/77), 14.3% (11/77), and 23.4% (18/77) respectively. Patients with GR at any of the three time points were classified into the GR group (20/77, 26%). Compared with the non-GR group, GR group had lower weight at birth. The incidence of systemic corticosteroid use, mostly with hydrocortisone, were greater in the GR group than the non-GR group. The parameters that indicate disease severity, including observed-expected lung-to-head ratio, liver herniation, inhaled nitric oxide use, ECMO, patch repair did not differ between the two groups. Multivariate analysis revealed that low birthweight and systemic corticosteroid use were associated with increased odds of GR. Cumulative corticosteroid exposure was associated with impaired height growth, particularly during the first two years.
For the first 3 years of age, GR was observed a significant portion of CDH survivors. Early identification of high-risk patients and targeted interventions, including minimizing corticosteroid exposure and optimizing nutritional support, may improve growth outcomes in this vulnerable population.
生长发育迟缓（GR）是先天性膈疝（CDH）的主要发病情况之一。本研究旨在调查CDH幸存者生长发育不良的患病率及围产期危险因素。
我们回顾性分析了孕周≥35周且存活至3岁的孤立性CDH患者的病历。在1岁、2岁和3岁时测量体重和身长（身高）。当体重或身高的Z值低于-2.0时定义为生长发育迟缓。我们分析并比较了生长发育迟缓组和非生长发育迟缓组的产前和临床特征，包括人体测量数据、胎儿肺容积测量以及初次住院期间的治疗方式。
116例孤立性CDH患者中，86例存活至从新生儿重症监护病房出院（74.1%）。本研究分析纳入了77例存活3年且有后续生长参数的患者。1岁、2岁和3岁时生长发育迟缓的发生率分别为15.6%（12/77）、14.3%（11/77）和23.4%（18/77）。在这三个时间点中任何一个出现生长发育迟缓的患者被归入生长发育迟缓组（20/77，26%）。与非生长发育迟缓组相比，生长发育迟缓组出生体重较低。生长发育迟缓组全身使用皮质类固醇（主要是氢化可的松）的发生率高于非生长发育迟缓组。两组之间，反映疾病严重程度的参数，包括观察到的预期肺头比、肝脏疝出、吸入一氧化氮的使用、体外膜肺氧合、补片修补等并无差异。多因素分析显示，低出生体重和全身使用皮质类固醇与生长发育迟缓几率增加相关。累积皮质类固醇暴露与身高增长受损有关，尤其是在头两年。
在3岁前，相当一部分CDH幸存者出现生长发育迟缓。早期识别高危患者并进行针对性干预，包括尽量减少皮质类固醇暴露和优化营养支持，可能改善这一脆弱人群的生长结局。
