Related Experiment Video
Updated: Jun 5, 2026
Transuterine Fetal Tracheal Occlusion Model in Mice
Published on: February 5, 2021
Long term follow-up in high-risk congenital diaphragmatic hernia survivors: patching the diaphragm affects the
Laura Valfrè1, Annabella Braguglia, Andrea Conforti
1Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Research Hospital, 00165 Rome, Italy. laura.valfre@opbg.net
Insights
Patch repair for congenital diaphragmatic hernia (CDH) is linked to increased pulmonary, growth, and reflux issues. This study found no increase in chest wall deformities long-term.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Thoracic Surgery
Background:
- Improved survival rates in congenital diaphragmatic hernia (CDH) have led to increased focus on long-term morbidity.
- Diaphragmatic defect size is a known mortality risk factor, but its impact on late morbidity remains debated.
Purpose of the Study:
- To assess the midterm impact of patch repair, serving as a proxy for diaphragmatic defect size, on the morbidity of CDH survivors.
Main Methods:
- A prospective longitudinal study followed high-risk CDH survivors from 2004-2008.
- Evaluations included auxological, gastroesophageal, pulmonary, and orthopedic assessments at 6, 12, and 24 months.
- Outcomes were compared between patients who received patch repair versus those who did not.
Main Results:
- Of 61 evaluated survivors, poorer auxological outcomes were observed.
- Increased rates of gastroesophageal reflux were noted in the follow-up cohort.
- Altered pulmonary function test results were also identified.
Conclusions:
- Patch repair in CDH survivors is associated with increased pulmonary, auxological, and gastroesophageal morbidity.
- No significant increase in chest wall deformities was observed at long-term follow-up related to patch repair.
Background/Purpose:
The increased survival rate reached in infants with congenital diaphragmatic hernia (CDH) has shown a concomitant increase in late morbidity. A recent report from CDH Study Group showed that dimension of diaphragmatic defect is the only independent risk factor of mortality. However, the influence of defect size on late morbidity is still controversial. The aim of the study was to evaluate the influence of patch repair (proxy of diaphragmatic defects size) on midterm morbidity.
Methods:
All high-risk (prenatal diagnosis and/or respiratory symptoms within 6 hours of life) CDH survivors treated at our institution from 2004 to 2008 were followed up in a multidisciplinary outpatient clinic as part of a longitudinal prospective study. Auxological, gastroesophageal, pulmonary, and orthopedic evaluations were performed at 6, 12, and 24 months of age. Patient outcomes were compared with respect to +/- patch repair.
Results:
Of 70 survivors, 61 (87%) were enrolled and prospectively evaluated in follow-up. Poorer auxological outcome, increased rate of gastroesophageal reflux, and altered pulmonary function test were observed during follow-up.
Conclusions:
Patch repair correlates with higher pulmonary, auxological, and gastroesophageal morbidity without increasing chest wall deformities at long-term follow-up.
