Elsevier

Journal of Pediatric Surgery

Volume 44, Issue 9, September 2009, Pages 1683-1690
Journal of Pediatric Surgery

Original article
A prospective comparative evaluation of persistent respiratory morbidity in esophageal atresia and congenital diaphragmatic hernia survivors

https://doi.org/10.1016/j.jpedsurg.2008.12.019Get rights and content

Abstract

Purpose

The aim of the study was to compare long-term respiratory morbidity in children after repair of esophageal atresia (EA) or congenital diaphragmatic hernia (CDH).

Patients and Methods

Children were seen at 6, 12, and 24 months and 5 years within a prospective longitudinal follow-up program in a tertiary children's hospital. Respiratory morbidity and physical condition were evaluated at all moments. At age 5 years, pulmonary function and maximal exercise performance were tested.

Results

In 3 of 23 atresia patients and 10 of 20 hernia patients, bronchopulmonary dysplasia was developed. Seventeen atresia and 11 hernia patients had recurrent respiratory tract infections mainly in the first years of life. At age 5, 25% of EA and CDH patients measured showed reduced forced expiratory volume in 1 second (z-score < −2). Both atresia and hernia patients showed impaired growth, with catch-up growth at 5 years in patients with EA but not in those with hernia. Maximal exercise performance was significantly below normal for both groups.

Conclusions

Esophageal atresia and CDH are associated with equal risk of long-term respiratory morbidity, growth impairment, and disturbed maximal exercise performance. Prospective follow-up of EA patients aimed at identifying respiratory problems other than tracheomalacia should be an integral part of interdisciplinary follow-up programs.

Section snippets

Methods

This longitudinal, observational, prospective, cohort study consists of repeated measurements at 6, 12, and 24 months and at 5 years.

Results

Baseline characteristics for both groups of children are shown in Table 1. All CDH patients were born after a gestational age of at least 36 weeks; 4 EA patients were born before 36 weeks of gestation at 28, 29, 31, and 33 weeks, respectively. All but one EA children underwent primary anastomosis via a lateral thoracotomy within 48 hours. One patient had a type A long gap atresia and underwent delayed primary anastomosis after 3 months. Bronchoscopic evaluation of tracheomalacia during the

Discussion

We prospectively evaluated respiratory morbidity and factors interrelating with pulmonary disease during the first 5 years in 2 groups of children born with major congenital anatomical malformations of the respiratory tract—EA and CDH. Both groups showed recurrent respiratory tract infections, abnormally low FEV1 in 25% of patients, no increase of FEno levels, and decreased maximal exercise tolerance. In addition, a high incidence of GER and impaired physical growth were observed in both groups.

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    Monique H. van der Cammen-van Zijp received an unrestricted grant from Fonds Nuts-Ohra, grant number 0701-83.

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