Prevalence and perinatal risk factors of growth retardation in congenital diaphragmatic hernia survivors.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.