Link: http://www.ncbi.nlm.nih.gov/pubmed/26465794

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J Pediatr Gastroenterol Nutr. 2015 Oct 9. [Epub ahead of print]
Nutritional Intake, Energy Expenditure and Growth of Infants Following Congenital Diaphragmatic Hernia Repair.
Haliburton B1, Chiang M, Marcon M, Moraes TJ, Chiu PP, Mouzaki M.
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Abstract
BACKGROUND/OBJECTIVES:
The pathophysiology of failure to thrive (FTT) in 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 CDH infants to grow optimally at the time of first hospital discharge. The secondary objectives were to assess their measured resting energy expenditure (mREE) in infancy, and their long-term growth outcomes.

METHODS:
Nutritional intake, anthropometrics, indirect calorimetry results and respiratory status of CDH infants 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 USA).

RESULTS:
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/d). In a subset of 17 patients, mREE was higher than predicted resting energy expenditure (pREE) (58.0 ? 18 vs. 46.6 ? 3 kcal/kg/day, p < 0.05), and 59% of infants were hypermetabolic (mREE>110% of pREE) in early infancy. FTT prevalence at discharge was 16.2% compared to 3.6% at 12- and 4.2% at 24- months of age (p = 0.03; p = 0.005, respectively).

CONCLUSION:
Optimal weight gain can be achieved with higher than predicted calorie provision. The majority of CDH infants are hypermetabolic. Despite this, FTT prevalence can improve during the first year of life.