The association between nutritional intakes and growth trajectories among infants with congenital diaphragmatic hernia: A retrospective cohort study

BACKGROUND: Congenital diaphragmatic hernia is a critical neonatal condition frequently associated with growth impairment. Nutritional strategies to support adequate growth remain poorly defined. OBJECTIVE: To evaluate the association between caloric and protein intake, timing of parenteral and enteral nutrition, and changes in anthropometric z-scores during neonatal hospitalization in infants with congenital diaphragmatic hernia. METHODS: Retrospective cohort study including infants with congenital diaphragmatic hernia who underwent surgical repair at a single center between 2018 and 2023. Data were collected from birth to discharge or 12th week of hospitalization. Weekly deltas in anthropometric z-scores-weight-for-age, length-for-age, and head circumference-for-age-were calculated. Daily caloric and protein intakes were estimated and averaged weekly; timing of parenteral and enteral nutrition and disease-related factors were obtained and associations with anthropometric z-score deltas were analyzed. RESULTS: A total of 117 infants were included. Overall, 65% experienced z-score declines ≥0.8 across all anthropometric z-scores. Receiver operating characteristic (ROC) curve analysis identified a caloric intake of 113 kcal/kg/day as predictive of positive weight-for-age z-score deltas (area under curve 0.67) with improved specificity at 118 kcal/kg/day. In multivariable linear mixed-effects model, higher caloric intake (p < 0.001) and longer duration of mechanical ventilation (p = 0.01) were independently associated with positive weekly weight-for-age z-score deltas. Additionally, higher caloric intake was independently associated with positive weekly head circumference-for-age z-score deltas (p = 0.02). CONCLUSIONS: Growth impairment during hospitalization was highly prevalent among infants with congenital diaphragmatic hernia. A caloric intake of at least 113 kcal/kg/day, with an optimal threshold near 118 kcal/kg/day, may help prevent further deterioration in weight status.