WIP 43 - Enteral Nutrition Practices and Outcomes in Neonates with Congenital Diaphragmatic Hernia Receiving Extracorporeal Life Support

Publication Number: WIP 43.7566

John J. Morelli, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Jennie Godwin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Ekta Patel, Children's Mercy Kansas City, Kansas City, MO, United States

Background: Congenital diaphragmatic hernia (CDH) occurs in approximately 1 in 3000 live births. Due to increased incidence of pulmonary hypoplasia and pulmonary hypertension, these infants frequently require cannulation to extracorporeal life support (ECLS); these infants often receive repair of their underlying defect while on ECLS. Infants with CDH face significant challenges in achieving adequate growth, both in the short and long term. Their hypermetabolic state increases nutritional needs and place them at heightened risk for growth failure, a concern closely linked to adverse neurodevelopmental outcomes. In CDH management, a cautious transition from parenteral nutrition (PN) to enteral nutrition (EN) is generally initiated once infants stabilize following surgical repair. However, no national guidelines currently specify when to begin EN in infants with CDH. In addition, due to concerns for ischemic gut injury, ECLS is known to further delay feeding initiation in infants. This study examines our institution’s approach to initiating EN in post-repair CDH infants on ECLS.

Objective: To characterize EN feeding practices and safety outcomes in neonatal patients with CDH receiving ECLS.

Design/Methods: We conducted a retrospective chart review of CDH infants admitted to Children’s Mercy Kansas City, a level IV neonatal intensive care unit, who received ECLS between January 1, 2013, and December 31, 2023. Patients with congenital heart disease, genetic syndromes, or other major congenital anomalies were excluded. Institutional Review Board approval was obtained prior to data collection. The primary outcome assessed was mortality. Secondary outcomes included EN-related complications including necrotizing enterocolitis, aspiration pneumonia, and gastrointestinal hemorrhage, as well as time to full feeds, bolus vs. continuous feeding methods, gastric vs. transpyloric feed routes, and discharge metrics (z-scores for weight, length, and head circumference). We also evaluated nutrition type (breast milk vs. formula) and feeding method (all oral vs. tube) at discharge.