# Growth challenges and recovery in 1247 children with congenital diaphragmatic hernia: a 10-year follow-up

## TL;DR

This study tracks the long-term growth of 1247 children with congenital diaphragmati hernia and finds that while some growth delays improve, weight and BMI remain low.

## Contribution

The study provides long-term growth data for a large CDH cohort and identifies predictors of poor growth outcomes.

## Key findings

- Height and head circumference normalize by early childhood, but weight and BMI remain below average.
- Large defect size and lower gestational age are key predictors of growth restriction.
- ECMO therapy does not independently increase the risk of low weight or small stature.

## Abstract

Growth abnormalities in children with congenital diaphragmatic hernia (CDH) are a significant concern for long-term developmental outcomes. To explore growth in this population, the evolution of weight, height, body mass index (BMI), and head circumference as vital indicators of growth and developmental progress in CDH survivors were investigated. We analyzed 1247 CDH patients treated at our center from 2000 to 2022. Growth trends regarding weight, height, BMI, and head circumference of surviving patients without major comorbidities were compared with standard pediatric growth milestones for term and preterm children. Factors associated with growth disparities were assessed. A total of 835 CDH survivors without major comorbidities were identified who exhibited notably slower weight gain, which stabilized at a reduced level beyond the age of 2 years. By 6 years of age, height normalized in term-born children, while head circumference normalized at 1 year of age. BMI remained low throughout childhood. Defect size and gestational age were important independent predictors of growth restriction, whereas ECMO therapy was not an independent risk factor for low weight or small stature. Preterm children tended to exhibit lower growth percentiles and delayed catch-up.

Conclusion This study reveals that while initial growth is typically delayed in CDH survivors, a significant number achieve catch-up in childhood. The results lay the groundwork for personalized nutritional and therapeutic strategies to enhance growth outcomes in children with CDH.

What is Known:• Children with congenital diaphragmatic hernia frequently experience early growth failure and undernutrition.• Existing studies include ≤ 200 patients and tend to provide only short-term follow-up data.What is New:• A cohort of 1247 CDH patients was treated at our center; in survivors without major comorbidities, growth was evaluated repeatedly up to 14 years.• Height and head circumference normalize, whereas weight and BMI remain lower; large defect size and lower gestational age, but not ECMO, predict poor growth.

The online version contains supplementary material available at 10.1007/s00431-025-06479-w.