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Pulmonary function and exercise capacity in survivors of congenital diaphragmatic hernia

M G Peetsold1, H A Heij, A F Nagelkerke

  • 1Dept of Paediatrics, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. m.peetsold@vumc.nl

The European Respiratory Journal
|March 14, 2009
PubMed

Insights

Survivors of high-risk congenital diaphragmatic hernia (CDH) often have mild lung function deficits. Gastro-oesophageal reflux disease may contribute to these pulmonary issues in children with CDH.

Area of Science:

  • Pediatric Pulmonology
  • Congenital Abnormalities
  • Respiratory Medicine

Background:

  • Congenital diaphragmatic hernia (CDH) is linked to underdeveloped lungs and high blood pressure in the lungs.
  • Early respiratory distress defines high-risk CDH, necessitating long-term outcome assessment.

Purpose of the Study:

  • To evaluate pulmonary function and exercise capacity in children and adolescents with high-risk CDH.
  • To identify early factors influencing pulmonary outcomes in CDH survivors.
  • To correlate findings with the initial severity of CDH.

Main Methods:

  • Pulmonary function tests (spirometry, lung volumes) and maximal cardiopulmonary exercise testing (CPET) were performed on 53 high-risk CDH survivors (mean age 11.9 years).
  • Results were compared to a matched healthy control group.
  • Linear regression analyzed determinants of pulmonary function.

Main Results:

  • CDH survivors exhibited significantly reduced FEV(1), FVC, FEV(1)/FVC, and peak expiratory flow compared to controls.
  • A higher residual volume/total lung capacity ratio was observed in CDH survivors.
  • Gastro-oesophageal reflux disease was identified as an independent factor for decreased FEV(1) and FVC.

Conclusions:

  • High-risk CDH survivors present with mild to moderate pulmonary function abnormalities.
  • Pulmonary issues may be associated with early-life gastro-oesophageal reflux disease.
  • Exercise capacity and gas exchange were generally normal, suggesting minimal physical impairment for most survivors.

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