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Large diaphragmatic defect: are skeletal deformities preventable?
P Kuklová1, D Zemková, M Kyncl
1Department of Pediatric Surgery, 2nd Faculty of Medicine and University Hospital Motol, Charles University in Prague, V úvalu 84, 15000, Prague 5, Czech Republic.
Insights
Children with congenital diaphragmatic hernia (CDH) show impaired growth and nutritional status. Chest wall deformities like pectus excavatum are common, with differences noted between Gore-Tex patch and primary repair methods.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Thoracic Surgery
Background:
- Congenital diaphragmatic hernia (CDH) is a complex condition affecting infant development.
- Skeletal deformities and growth issues are potential long-term complications in CDH survivors.
- Understanding the impact of surgical repair methods on outcomes is crucial.
Purpose of the Study:
- To compare growth, nutritional status, and the incidence of chest wall deformities and scoliosis in CDH survivors.
- To evaluate differences between large defects repaired with Gore-Tex patch versus smaller defects with primary reconstruction.
Main Methods:
- An anthropometric study of 53 children post-CDH repair was conducted.
- Measurements included weight, height, skin-fold thickness, BMI, and thoracic index (TI).
- Patients were grouped by repair type: Gore-Tex patch (10) vs. primary repair (43).
Main Results:
- CDH survivors exhibited significantly lower height, weight, BMI, and TI SDS compared to population norms.
- Pectus excavatum (47%) and poor posture (33%) were prevalent; scoliosis occurred in 5%.
- The Gore-Tex group showed a higher incidence of pectus excavatum and lower BMI SDS compared to the primary repair group.
Conclusions:
- CDH impacts somatic development beyond lung growth, affecting anthropometric parameters and skeletal structure.
- The type of diaphragmatic reconstruction may influence specific outcomes like BMI and pectus excavatum incidence.
- Further research is needed to determine if observed changes relate to repair type or defect size.
Purpose:
The aim of study was to compare growth, nutritional status and incidence of chest wall deformities and scoliosis in survivors of large congenital diaphragmatic hernia (CDH) defect (Gore-Tex patch reconstruction) with survivors with smaller defects and primary reconstruction.
Materials And Methods:
An anthropometric study of 53 children who underwent CDH repair in neonatal period was carried out. Weight, height, and skin-fold thickness were measured, scoliosis and chest wall deformity were evaluated. Body mass index (BMI) and thoracic index (TI) were calculated using standard rules. The measured data were compared with national population standard with the use of standard deviation score (SDS). According to the type of diaphragmatic reconstruction, the patients were divided into two groups [Gore-Tex patch (10) versus primary repair (43)]. Student t test and Fisher exact tests were used for statistical analysis.
Results:
Pectus excavatum was found in 25 (47%) patients, poor posture in 33% and significant scoliosis in 5%. Compared with the population norm, CDH children had a significantly lower body height SDS (mean -0.39, p < 0.05), weight SDS (mean -0.75, p < 0.001), BMI (mean SDS -0.68, p < 0.001) and lower TI (mean SDS -0.62, p < 0.01). Gore-Tex versus primary repair group significantly differed in incidence of pectus excavatum and BMI (PE: p = 0.027, BMI SDS: p = 0.016). A majority of anthropometric parameters (weight, height, thoracic index, and thorax circumference) and incidence of scoliosis and poor posture in children after Gore-Tex patch reconstruction did not significantly differ from children after primary repair.
Conclusion:
The differences in some anthropometric parameters (weight, BMI, and TI) and in the skeletal deformity suggest that the CDH not only disturbs normal lung growth, but also seems to have implications on some other aspects of somatic development. Whether these changes could be related to the type of diaphragmatic reconstruction or rather to the size of the defect remains uncertain.
