436 - Feeding Outcomes in Congenital Diaphragmatic Hernia: A Single-Center Retrospective Study

Poster Number: 436
Publication Number: 436.1861

Background: Enteral feeding in infants with congenital diaphragmatic hernia (CDH) is challenging due to multiple comorbidities, including lung disease, pulmonary hypertension, and gastroesophageal reflux. Infants with CDH may have feeding intolerance, ileus, prolonged TPN dependence, and prolonged need for tube feeds. Historically, CDH repair involved an open surgical approach; however, minimally invasive repair (MIR) is becoming more common.

Objective: The aim of this study is to describe feeding outcomes of infants with CDH at a single-center NICU.

Design/Methods: This is a retrospective observational study from a single institution NICU between 2017-2022. A total of 20 infants were included who were admitted and had not been established on enteral feeds previously and who survived to achieve full-volume feeds. Statistical analysis was performed using t-test for continuous variables and Fisher exact test for categorial variables. A p-value < 0.05 was considered statistically significant.

Results: Twenty patients were identified, and 11 underwent open CDH repair (OR). Characteristics of the cohort are described in Table 1. A greater proportion of OR patients required ECLS and died before hospital discharge compared to the MIR group, though this was not statistically significant. Feeding outcomes are described in Table 2. 70% of patients received breast milk while inpatient. The median time to full feeds, TPN days, and central line days were 17.5, 18, and 22 days respectively. 65% of babies were discharged home on some oral feeds, 45% on supplemental nasogastric feeds, and 40% on either exclusive or partial breast milk diets. Feeding and nutritional outcomes were comparable between OR and MIR groups, except for fewer TPN days in the MIR group (12.5 vs 32 days, p = 0.04). The time to full feeds was not statistically different between groups, however the interquartile range in the OR group was larger than that of the MIR group (74 days vs 13 days).

Conclusion(s): The majority of infants in this cohort were fed breast milk during hospitalization and discharged home on oral or combined oral and nasogastric feeds. Infants who underwent minimally invasive repair had fewer TPN days. The time to full feeds was not statistically significant between groups, which may be due to the small sample size. These results may be confounded by greater cardiopulmonary stability in infants with CDH who undergo a minimally invasive surgery; however, surgical approach may impact timing of enteral feeding.