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First-year growth trajectory and early nutritional requirements for optimal growth in infants with congenital diaphragmatic hernia: a retrospective cohort study
  1. Maxime Coignard1,
  2. Kelly Mellul1,
  3. Julien Stirnemann2,3,
  4. Naziha Khen-Dunlop4,
  5. Alexandre Lapillonne1,3,
  6. Elsa Kermorvant-Duchemin1,3
  1. 1 Department of Neonatal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
  2. 2 Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
  3. 3 UFR de Médecine, Université Paris Cité, Paris, France
  4. 4 Department of Paediatric Surgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France
  1. Correspondence to Professor Elsa Kermorvant-Duchemin, Department of Neonatal Medicine, Hopital universitaire Necker-Enfants malades, Paris, 75015, France; elsa.kermorvant{at}


Objective To describe the growth trajectory of children with congenital diaphragmatic hernia (CDH) during the first year, to assess the risk factors for growth failure (GF) at 1 year and to determine nutritional intakes at discharge required for early optimal growth.

Design Single-centre retrospective cohort study based on data from a structured follow-up programme.

Setting and patients All neonates with CDH (2013–2019) alive at discharge and followed up to age 1.

Interventions None.

Main outcome measures Weight-for-age z-score (WAZ) at birth, 3, 6 and 12 months of age; risk factors for GF at age 1; energy and protein intake of infants achieving early optimal growth.

Results Sixty-three of 65 neonates who were alive at discharge were included. Seven (11%) had GF at 1 year and 3 (4.8%) had a gastrostomy tube. The mean WAZ decreased in the first 3 months before catching up at 1 year (−0.6±0.78). Children with a severe form or born preterm experienced a deeper loss (from −1.5 to −2 z-scores) with late and limited catch-up. The median energy intake required to achieve positive or null weight growth velocity differed significantly according to CDH severity, ranging from 100 kcal/kg/day (postnatal forms) to 139 kcal/kg/day (severe prenatal forms) (p=0.009).

Conclusions Growth patterns of CDH infants suggest that nutritional risk stratification and feeding practices may influence growth outcomes. Our results support individualised and active nutritional management based on CDH severity, with energy requirements as high as 140% of recommended intakes for healthy term infants.

  • neonatology
  • growth
  • intensive care units, neonatal
  • paediatrics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors MC and EK-D designed the study, collected the data and drafted the article. MC, EK-D and JS analysed the data. KM, JS, NK-D and AL critically revised the manuscript. EK-D accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding EK-D received a grant “Sauver la Vie 2020” from the Foundation Université Paris Cité.

  • Disclaimer The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.