Growth failure and early recurrence in congenital diaphragmatic hernia: An international cohort study.

PURPOSE: The primary objective was to determine whether growth failure (GF) is associated with early recurrence in congenital diaphragmatic hernia (CDH). The secondary objective was to characterize the prevalence and severity of GF in CDH survivors.

BACKGROUND

GF is common among CDH survivors, yet it is unclear how growth challenges affect overall morbidity, including hernia recurrence. CDH-specific nutritional guidelines include high calorie and protein targets during periods of acute illness but may benefit from clarifying the relationship between growth and adverse outcomes in this population.

METHODS

This multicenter cohort study retrospectively analyzed prospectively collected data from the CDH Study Group (CDHSG) registry. Weight-for-age Z-scores (WAZ) were calculated for CDH survivors born between 2007 and 2023 and GF was defined as WAZ <-2.0 at discharge from birth admission. Non-parametric tests and logistic regression analyses were employed.

RESULTS

Among 4931 CDH survivors, median gestational age and birth weight were 38 weeks and 3.1 kg, respectively (birth WAZ -0.24). Left-sided defects predominated (4205), with expected distribution by CDHSG stage: A (16 %), B (44 %), C (31 %), D (8 %). GF occurred in 14.6 % (720). Hernia recurrence occurred in 3.3 % (163), more commonly in those with GF: 6.4 % (46/720) versus 2.8 % (117/4211) (p < 0.001). GF patients had 80 % increased odds of early recurrence (adjusted odds ratio 1.8; 95 % CI 1.2-2.4; p = 0.007).

CONCLUSIONS

GF is a potentially modifiable risk factor for early CDH recurrence, underscoring the need for targeted nutritional protocols. Future studies should evaluate center-specific practices and assess long-term recurrence risk related to nutrition and growth.