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Predictors of gastroesophageal reflux in neonates with congenital diaphragmatic hernia
Wendy Su1, Margaret Berry, Pramod S Puligandla
1Department of Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada H3H1P3.
Insights
Gastroesophageal reflux (GER) is common in neonates with congenital diaphragmatic hernia (CDH). Patch repair and extracorporeal life support predict severe GER requiring fundoplication in these infants.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) affects a significant portion of neonates with congenital diaphragmatic hernia (CDH).
- Understanding predictors of GER requiring surgical intervention is crucial for managing these complex cases.
Purpose of the Study:
- To identify factors predicting the need for fundoplication in neonates with CDH.
Main Methods:
- Retrospective chart review of neonates with CDH from 1997-2005.
- Assessed preoperative respiratory status, CDH side, and repair method as predictors of GER and fundoplication.
Main Results:
- Of 39 eligible patients, 54% developed GER, and 23% required fundoplication.
- Patch repair and need for extracorporeal life support were significant predictors of GER and fundoplication.
- CDH side did not predict GER or the need for fundoplication.
Conclusions:
- GER is frequent in CDH but often resolves without surgery.
- Infants requiring patch repair or extracorporeal life support are at higher risk for severe GER needing fundoplication.
- Early recognition and intervention for high-risk infants can reduce morbidity and hospital stay.
Purpose:
Gastroesophageal reflux (GER) is observed in 22% to 81% of neonates with congenital diaphragmatic hernia (CDH). The purpose of this study was to identify factors that may predict GER requiring fundoplication in neonates with CDH.
Methods:
A retrospective chart review was performed on all neonates with CDH treated at our hospital from June 1997 to June 2005. Preoperative respiratory status, side of the CDH, and method of repair were assessed as predictors of GER and the need for fundoplication.
Results:
Of the 42 patients with CDH, 3 died before intervention, leaving 39 patients eligible for study. All but 1 patient survived until discharge. Twenty-one (54%) developed GER of whom 9 (23%) required fundoplication. Although the side of the CDH was not a determinant of GER or the need for fundoplication, patch repair and the need for extracorporeal life support were determinants of both.
Conclusions:
Gastroesophageal reflux is common among babies with CDH, although symptoms often resolve without surgical intervention. Infants with CDH defects requiring a patch repair and those requiring advanced physiologic support, especially extracorporeal life support, are likely to develop severe GER necessitating fundoplication. Early recognition and treatment of GER among high-risk patients may shorten hospital stay and minimize patient morbidity. Early fundoplication should be considered for those patients at the highest risk.
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