Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia
Background: Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/6/2415 |
| _version_ | 1797610953795174400 |
|---|---|
| author | Mélina Bourezma Sébastien Mur Laurent Storme Emeline Cailliau Pascal Vaast Rony Sfeir Arthur Lauriot Dit Prevost Estelle Aubry Kévin Le Duc Dyuti Sharma |
| author_facet | Mélina Bourezma Sébastien Mur Laurent Storme Emeline Cailliau Pascal Vaast Rony Sfeir Arthur Lauriot Dit Prevost Estelle Aubry Kévin Le Duc Dyuti Sharma |
| author_sort | Mélina Bourezma |
| collection | DOAJ |
| description | Background: Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral feeding autonomy in patients treated for CDH. Methods: This monocentric cohort study included 138 patients with CDH. Eighty-four patients were analyzed after the exclusion of 54 patients (11 with delayed postnatal diagnosis, 5 with chromosomal anomaly, 9 with genetic syndrom, 13 with right-sided CDH, and 16 who died before discharge and before oral feeding autonomy was acquired). They were divided into two groups: oral feeding autonomy at initial hospital discharge (group 1, <i>n</i> = 51) and nutritional support at discharge (group 2, <i>n</i> = 33). Antenatal, postnatal, and perisurgical data were analyzed from birth until first hospital discharge. To remove biased or redundant factors related to CDH severity, statistical analysis was adjusted according to the need for a patch repair. Results: After analysis and adjustment, delayed oral feeding autonomy was not related to observed/expected lung-to-head ratio (LHR o/e), intrathoracic liver and/or stomach position, or operative duration. After adjustment, prophylactic gastrostomy (OR adjusted: 16.3, IC 95%: 3.6–74.4) and surgical reoperation (OR adjusted: 5.1, IC 95% 1.1–23.7) remained significantly associated with delayed oral feeding autonomy. Conclusions: Delayed oral feeding autonomy occurred in more than one third of patients with CDH. Both prophylactic gastrostomy and surgical reoperation represent significant risk factors. Bowel obstruction might also impact oral feeding autonomy. Prophylactic gastrostomy seems to be a false “good idea” to prevent failure to thrive. This procedure should be indicated case per case. Bowel obstruction and all surgical reoperations represent decisive events that could impact oral feeding autonomy. |
| first_indexed | 2024-03-11T06:22:06Z |
| format | Article |
| id | doaj.art-71ca657eae894755a554146980bef327 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:22:06Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-71ca657eae894755a554146980bef3272023-11-17T11:52:33ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126241510.3390/jcm12062415Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic HerniaMélina Bourezma0Sébastien Mur1Laurent Storme2Emeline Cailliau3Pascal Vaast4Rony Sfeir5Arthur Lauriot Dit Prevost6Estelle Aubry7Kévin Le Duc8Dyuti Sharma9CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, FranceULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, FranceCenter for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, FranceCHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, FranceBackground: Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral feeding autonomy in patients treated for CDH. Methods: This monocentric cohort study included 138 patients with CDH. Eighty-four patients were analyzed after the exclusion of 54 patients (11 with delayed postnatal diagnosis, 5 with chromosomal anomaly, 9 with genetic syndrom, 13 with right-sided CDH, and 16 who died before discharge and before oral feeding autonomy was acquired). They were divided into two groups: oral feeding autonomy at initial hospital discharge (group 1, <i>n</i> = 51) and nutritional support at discharge (group 2, <i>n</i> = 33). Antenatal, postnatal, and perisurgical data were analyzed from birth until first hospital discharge. To remove biased or redundant factors related to CDH severity, statistical analysis was adjusted according to the need for a patch repair. Results: After analysis and adjustment, delayed oral feeding autonomy was not related to observed/expected lung-to-head ratio (LHR o/e), intrathoracic liver and/or stomach position, or operative duration. After adjustment, prophylactic gastrostomy (OR adjusted: 16.3, IC 95%: 3.6–74.4) and surgical reoperation (OR adjusted: 5.1, IC 95% 1.1–23.7) remained significantly associated with delayed oral feeding autonomy. Conclusions: Delayed oral feeding autonomy occurred in more than one third of patients with CDH. Both prophylactic gastrostomy and surgical reoperation represent significant risk factors. Bowel obstruction might also impact oral feeding autonomy. Prophylactic gastrostomy seems to be a false “good idea” to prevent failure to thrive. This procedure should be indicated case per case. Bowel obstruction and all surgical reoperations represent decisive events that could impact oral feeding autonomy.https://www.mdpi.com/2077-0383/12/6/2415congenital diaphragmatic herniafailure to thriveoral feeding autonomygastrostomysurgical reintervention |
| spellingShingle | Mélina Bourezma Sébastien Mur Laurent Storme Emeline Cailliau Pascal Vaast Rony Sfeir Arthur Lauriot Dit Prevost Estelle Aubry Kévin Le Duc Dyuti Sharma Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia Journal of Clinical Medicine congenital diaphragmatic hernia failure to thrive oral feeding autonomy gastrostomy surgical reintervention |
| title | Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia |
| title_full | Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia |
| title_fullStr | Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia |
| title_full_unstemmed | Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia |
| title_short | Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia |
| title_sort | surgical risk factors for delayed oral feeding autonomy in patients with left sided congenital diaphragmatic hernia |
| topic | congenital diaphragmatic hernia failure to thrive oral feeding autonomy gastrostomy surgical reintervention |
| url | https://www.mdpi.com/2077-0383/12/6/2415 |
| work_keys_str_mv | AT melinabourezma surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT sebastienmur surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT laurentstorme surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT emelinecailliau surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT pascalvaast surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT ronysfeir surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT arthurlauriotditprevost surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT estelleaubry surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT kevinleduc surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia AT dyutisharma surgicalriskfactorsfordelayedoralfeedingautonomyinpatientswithleftsidedcongenitaldiaphragmatichernia |