Long-term follow up of infants with congenital diaphragmatic hernia
Section snippets
Pulmonary outcome
Most adolescent CDH survivors are healthy and enjoy normal lives. However, in a significant proportion of patients, long-term pulmonary sequelae are detectable and dependent on the severity of lung hypoplasia and the degree of lung injury.8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23
Before the introduction of “advanced” treatment modalities (ECMO, gentle ventilation, HFV, iNO), long-term CDH survivors treated with conventional mechanical ventilation were reported healthy and without
Neurological outcome
A variable, but significant proportion of CDH survivors have neurological sequelae (Table 1), including developmental delay, motor, cognitive, and behavioral disorders.11, 15, 23, 25, 28, 30, 46, 47, 48, 49 Several factors are associated with neurodevelopmental outcome in CDH survivors. The need for ECMO seems related to a poorer neurological outcome. Some authors suggest that CDH patients treated with ECMO do less well than infants treated with ECMO for other reasons. Bernbaum and coworkers46
Gastrointestinal outcome
Gastroesophageal reflux (GER), with all its associated nutritional (and pulmonary) consequences, is the most common sequela.15, 65, 66, 67, 68, 69, 70 This condition was rarely referred to in association with CDH before 1990,66 but recent studies have shown that GER is commonly found in short- and long-term survivors of CDH.69, 70 A review of the incidence of GER among CDH patients in different studies is reported in Table 1. These data suggest that nearly 40% of babies operated on for CDH will
Musculoskeletal outcome
The close relationship between development of the lung, diaphragm, and thoracic cage is highlighted by the frequency of musculoskeletal abnormalities87, 88, 89 in children who have undergone CDH repair. Chest asymmetry and pectus deformity are the most commonly described, followed by vertebral deformity (scoliosis and kyphosis).10, 11, 16, 19, 22, 33, 58, 83, 90 Because chest wall and spinal deformities develop throughout the entire growth period, their true incidence may be defined only when
Quality of life
As previously stated, CDH patients face life-threatening morbidity during the neonatal period and some CDH-related symptoms during their first years of life.34, 58, 95 Disease-specific symptoms, not unique to CDH patients, are more frequently reported in CDH patients than in the general population. Poley at al96 found a significantly higher symptom score for CDH patients under the age of 19 (mean score 6.8) than for their contemporaries in the control group (mean score 4.9). Moreover, analyzing
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Impact of bowel rotation and fixation on obstructive complications in congenital diaphragmatic hernia
2023, Journal of Pediatric SurgeryCitation Excerpt :Bowel obstruction is known surgical complication after CDH repair. We observed a 9% rate of SBO complications in CDH patients, which is on the lower end of the range previously reported by others [8]. Patients typically present with obstructive symptoms within first few years of life, which is in agreement with our observations [17].
Long term outcomes in CDH: Cardiopulmonary outcomes and health related quality of life
2022, Journal of Pediatric SurgeryCitation Excerpt :A single yet crucially important paper has also focused additionally on the impact of CDH to the wider family [84]. These varied and useful published reports share some ideological themes [6,84–92]. The requirement for long term after care CDH follow-up has been arguably emphasized before [5,93].
Growth and morbidity in infants with Congenital Diaphragmatic Hernia according to initial lung volume: A pilot study
2022, Journal of Pediatric SurgeryAchieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge
2021, Journal of Pediatric SurgeryCitation Excerpt :Greater than 60% of infants with CDH exhibit growth failure throughout hospitalization that often persists into the first year of life [8,10–13]. Optimizing growth has the potential to improve survival through functional improvements in pulmonary hypoplasia, as well as motor, cognitive, and language domains of neurodevelopment [8,9,16]. Human milk (HM) is an optimal nutritional source for critically ill infants.
Lobectomy for acquired lobar emphysema months following newborn repair of congenital diaphragmatic hernia
2021, Journal of Pediatric Surgery Case ReportsIdentifying risk factors for enteral access procedures in neonates with congenital diaphragmatic hernia: A novel risk-assessment score
2021, Journal of Pediatric Surgery