Background/Purpose: Neonates with congenital diaphragmatic hernia (CDH) often exhibit insufficient oral intake and require enteral access. The purpose of this study was to evaluate the characteristics of neonates with CDH undergoing enteral access procedures during their initial hospitalization, and establish a clinical scoring system based on these characteristics. Methods: Data were obtained from the multicenter CDH Study Group database (CDHSG Registry). Patients born between 2007 and 2019 surviving to hospital discharge were randomly partitioned into model-derivation and validation subsets based on a 70/30 split. Logistic regression was utilized to identify the association between enteral access and each risk factor. Weighted scores were assigned to risk factors based on their calculated β-coefficients. The receiver operating characteristic (ROC) curve, calibration plot, and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the scoring system in the validation subset. Results: Of 4,537 total patients, 597 (13%) underwent an enteral access procedure. The majority underwent gastrostomy tube placement (99%), while 1% had a jejunostomy tube placed. Among patients in the derivation subset, factors independently associated with an increased risk for enteral access included oxygen requirement at 30-days, chromosomal abnormalities, gastroesophageal reflux, major cardiac anomalies, ECMO requirement, liver herniation, and increased defect size (Table). These factors were used to develop a 12-point scoring system, which performed well in the validation set based on ROC analysis (AUC 0.843, p<0.001), and was well calibrated (Hosmer-Lemeshow test (p>0.05). Based on their score, patients could be stratified into very low (0-4 points; <10% risk), low (5-6 points; 10-20% risk), intermediate (7-9 points; 30-60% risk), and high risk (≥10 points; 70% risk) groups for enteral access. Conclusion: This study identifies risk factors associated with enteral access procedures in neonates with CDH and establishes a novel scoring system that may be used to guide clinical decision making in those with poor oral feeding.

Risk factors associated with enteral access procedures and logistic regression-derived scoring system