Original articleImpaired somatic growth and delayed lung development in infants with congenital diaphragmatic hernia—evidence from a 10-year, single center prospective follow-up study
Section snippets
Subjects
Inpatients of our tertiary neonatal intensive care unit (NICU) were eligible for entry in this prospective study for 10 years. Twenty-six consecutive patients with CDH were enrolled in the study. These were matched with 26 non-CDH control patients all requiring neonatal intensive care. Matching was performed on a patient-by-patient basis with regard to gestational age and birth weight. Diaphragmatic defects were predominantly left-sided (n = 20; 77%), primary closure was performed in 18 (69%)
Statistical methods
Patient's characteristics between both groups were compared by χ2 test, the Fischer's Exact test, or Mann-Whitney rank test, as appropriate. Physiologic parameters are presented as mean with SD and compared by the t test for unpaired and paired samples, as appropriate. For statistical evaluation, the software Statgraphics (Vers. 5.0, Manugistics Inc, Rockville, Md) was used. A level of statistical significance of P < .05 was accepted.
Patients
The patient's characteristics showed no statistically significant differences with respect to gestational age, birth weight, or sex (Table 1). All patients received continuous positive airway pressure after extubation from mechanical ventilation. The duration of mechanical ventilation was significantly longer in CDH patients compared to controls (P < .001). The median duration of inpatient care was identical in both groups (both 34 days; P = .43) with a range of 18 to 223 days in CDH patients
Discussion
The study has shown that during the first weeks of life, there was a distinct and positive somatic development in both patient groups. However, after surgery for CDH, these patients had a significantly lower weight gain per week than controls (P < .002). Significant differences in pulmonary function were seen between CDH and non-CDH infants regarding parameters of tidal breathing (VT, RR, minute volume) and Crs but no statistically significant differences in Rrs and FRCpleth.
To our knowledge,
Acknowledgment
We thank Mrs S. Wilitzki for carrying out the LFTs, Mrs J. Blank for helping with the data analysis, and special thanks to Dr Peter Waugh for language editing.
References (28)
Factors adversely affecting lung growth
Paediatric Respir Rev
(2000)- et al.
Current therapy of infants with congenital diaphragmatic hernia
Semin Neonatol
(2003) - et al.
Evidence-based management of infants with congenital diaphragmatic hernia
Semin Perinatol
(2005) - et al.
Nutritional morbidity in survivors of congenital diaphragmatic hernia
J Pediatr Surg
(2001) - et al.
Lung function in infants after repair of congenital diaphragmatic hernia
J Ped Surg
(2006) - et al.
Outcome at 2 years of infants with congenital diaphragmatic hernia: a population-based study
Ann Thorac Surg
(2003) - et al.
The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in long-term morbidity?
J Pediatr Surg
(2006) - et al.
The role of nutrition in the prevention and management of bronchopulmonary dysplasia
Semin Perinatol
(2006) - et al.
Expiratory flow limitation in infants with bronchopulmonary dysplasia
J Pediatr
(1986) - et al.
Influence of preterm onset of inspiration on tidal breathing parameters in infants with and without CLD
Respir Physiol Neurobiol
(2003)
Lung function at term reflects severity of bronchopulmonary dysplasia
J Pediatr
Recent advances in congenital diaphragmatic hernia
Arch Dis Child
Symposium - Interdisciplinary update on congenital diaphragmatic hernia
Monatsschr Kinderheilkd
Survival of severe congenital diaphragmatic hernia has morbid consequences
J Pediatr Surg
Cited by (23)
Case report: 19M old boy with Morgagni Hernia associated with intestinal malrotation
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :The reported incidence of congenital diaphragmatic hernia (CDH) is between 1 in 2000 and 5000 births, approximately one-third of which are stillborn. Diaphragmatic hernias are typically left-sided (80%), though right-sided and bilateral CDH do also occur [1–4]. The traditionally described left-sided anomaly is a 2–4 cm posterolateral defect, termed a Bochdalek hernia, through which abdominal contents (usually the left lobe of the liver, the spleen, and the gastrointestinal tract) herniate into the hemithorax.
Resting energy expenditure in infants with congenital diaphragmatic hernia without respiratory support at time of neonatal hospital discharge
2018, Journal of Pediatric SurgeryCitation Excerpt :If we compare REE measurements of infants in our cohort to this previously published data from healthy term infants there were no statistically significant difference in REE between the infants with CDH and healthy term infants of similar post-natal age (mean difference − 3.79; 95.00% CI = − 13.5-5.9; t = − 1.25; p = 0.30) receiving similar caloric intakes (mean difference 9.25; 95% CI -25.5 to 43.9; t = 0.84; p = 0.46) (Table 2). These findings do not support our initial hypothesis and deviate from the long-standing assumption that these patients are hyper-metabolic [37,38]. There are varied possibilities as to why we did not find infants with CDH to be hyper-metabolic.
Long-term morbidity of congenital diaphragmatic hernia: A plea for standardization
2017, Seminars in Pediatric SurgeryLong-term follow-up of congenital diaphragmatic hernia
2017, Seminars in Pediatric SurgeryCitation Excerpt :GERD is most likely one of multiple contributors to poor growth in the population of survivors with CDH. Particularly in high-risk children who spend many days on the ventilator, oral aversion, and respiratory difficulty are common.7,41,46 In the perinatal period, time to achieve full enteral feedings can reach up to 3 weeks post-repair on average and even longer in patients with more severe GERD.47
Pulmonary function and nutritional morbidity in children and adolescents with congenital diaphragmatic hernia
2017, Journal of Pediatric SurgeryCitation Excerpt :We studied a cohort of 33 CDH survivors and found that lung function correlated with reduced BMI; however energy expenditure at rest could not be correlated with either BMI or lung function. Decreased pulmonary function is common among CDH children and adolescents [24] and has often been proposed as a contributing factor to poor nutritional status [7,8,16,17] with so called “work-of-breathing” causing elevated energy expenditure. In this study, we demonstrated a correlation between pulmonary function and BMI; however, no correlation between energy expenditure and lung function (FEV1 and FVC) was found.
Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence
2015, Journal of Pediatric SurgeryCitation Excerpt :Of the subset of patients who were assessed by indirect calorimetry, the majority was found to have elevated energy requirements, suggesting that hypermetabolism may be contributing to FTT in this setting. FTT has been documented in young children with CDH [1–9]. It has been postulated to be the result of comorbidities that affect intake (e.g. oral aversion, GERD etc.), as well as surgical techniques used at the time of the diaphragmatic repair [7,8].