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Long-term functional impact of congenital diaphragmatic hernia repair on children
Catherine Chen1, Stefanie Jeruss, Jocelyn S Chapman
1Department of Surgery, Children's Hospital, Boston, MA 02115, USA. catherine.chen@childrens.harvard.edu
Insights
Long-term survivors of congenital diaphragmatic hernia (CDH) often experience ongoing medical issues, impacting their functional status years after surgical repair. Early identification and interventions are crucial for affected children and families.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Developmental Pediatrics
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect requiring immediate surgical intervention.
- Neonatal survival rates for CDH exceed 90% due to advancements in surgical care.
- Long-term outcomes and functional impact on survivors are not fully understood.
Purpose of the Study:
- To assess the long-term functional status of children who underwent surgical repair for CDH.
- To identify factors influencing functional outcomes in CDH survivors.
- To evaluate the relationship between medical morbidity and functional status in this cohort.
Main Methods:
- A cross-sectional study involving 53 families of CDH survivors.
- Functional impact assessed using parent-reported measures: Functional Status II R and Child Health Ratings Inventories General Health Module.
- Clinical severity, medical history, and demographic data were collected.
Main Results:
- CDH survivors had a median age of 8 years; 48% had ongoing clinical problems.
- Lower functional status (Functional Status II R total score) was significantly correlated with clinical severity (r = -0.65; P < .0001).
- Children with persistent medical issues reported worse functional status.
Conclusions:
- A significant subset of CDH survivors experience long-term medical issues affecting their functional status.
- Ongoing clinical problems are evident a median of 8 years post-surgery.
- Proactive identification and sustained interventions are recommended for CDH survivors and their families.
Background/Purpose:
Congenital diaphragmatic hernia (CDH) is a malformation requiring neonatal surgical repair with in-hospital survival rates above 90%. We examined the long-term functional impact of CDH repair on a cross-sectional cohort of survivors.
Methods:
A cohort of 53 CDH families participated in this study. Functional impact was evaluated with parent report of the Functional Status IIR and the Child Health Ratings Inventories General Health Module. Parents also provided a clinical severity score, the child's medical history, and family demographic information. The primary outcome was the effect of medical morbidity on the Functional Status IIR total score.
Results:
Congenital diaphragmatic hernia survivors had a median age of 8 years; 50% were in third grade or above. Sixty-six percent had major medical issues at hospital discharge, whereas 48% had current clinical problems. Functional Status IIR total score was strongly correlated with child's clinical severity (r = -0.65; P < .0001) and was lower among children with ongoing medical morbidity, denoting worse functioning (P = .01). Child Health Ratings Inventories General Health Module scores followed a similar pattern.
Conclusions:
A subset of long-term CDH survivors continues to have ongoing clinical problems a median of 8 years after surgery, translating to lower functional status. Affected children and their families may benefit from prospective identification and ongoing interventions.
