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Developmental outcomes of children with congenital diaphragmatic hernia: a multicenter prospective study
Julia Wynn1, Gudrun Aspelund, Annette Zygmunt
1Department of Pediatrics, Columbia University, New York, NY 10032, USA.
Insights
Children with congenital diaphragmatic hernia (CDH) show lower developmental scores by age 2. Factors like ECMO, oxygen use, and socioeconomic status impact these outcomes.
Area of Science:
- Pediatric Medicine
- Developmental Pediatrics
- Neonatology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect affecting lung development.
- Early developmental outcomes in CDH patients require comprehensive assessment.
Purpose of the Study:
- To evaluate developmental outcomes at 2 years of age in infants with CDH.
- To identify factors associated with developmental delays in this cohort.
Main Methods:
- A multicenter prospective study followed a CDH birth cohort.
- Bayley Scales of Infant Development (BSID-III) and Vineland Adaptive Behavior Scales (VABS-II) were administered at 2 years.
- Clinical, socioeconomic, and medical data were collected.
Main Results:
- CDH patients exhibited significantly lower mean cognitive, language, and motor scores compared to norms.
- Lower socioeconomic status, need for extracorporeal membrane oxygenation (ECMO), oxygen at 28 days, and tube feeds were associated with poorer outcomes.
- Hospital readmissions and ongoing need for tube feeds at 2 years also correlated with lower scores.
Conclusions:
- Infants with CDH demonstrate, on average, delayed development at 2 years of age.
- Factors including severe initial treatment (ECMO), prolonged oxygen support, persistent health issues, and lower socioeconomic status are linked to these developmental deficits.
Purpose:
To determine developmental outcomes and associated factors in patients with congenital diaphragmatic hernia (CDH) at 2 years of age.
Methods:
This is a multicenter prospective study of a CDH birth cohort. Clinical and socioeconomic data were collected. Bayley Scales of Infant Development (BSID-III) and Vineland Adaptive Behavior Scales (VABS-II) were performed at 2 years of age.
Results:
BSID-III and VABS-II assessments were completed on 48 and 49 children, respectively. The BSID-III mean cognitive, language, and motor scores were significantly below the norm mean with average scores of 93 ± 15, 95 ± 16, and 95 ± 11. Ten percent (5/47) scored more than 2 standard deviations below the norm on one or more domains. VABS-II scores were similar to BSID-III scores with mean communication, daily living skills, social, motor, adaptive behavior scores of 97 ± 14, 94 ± 16, 93 ± 13, 97 ± 10, and 94 ± 14. For the BSID-III, supplemental oxygen at 28 days, a prenatal diagnosis, need for extracorporeal membrane oxygenation (ECMO) and exclusive tube feeds at time of discharge were associated with lower scores. At 2 years of age, history of hospital readmission and need for tube feeds were associated with lower scores. Lower socioeconomic status correlated with lower developmental scores when adjusted for significant health factors.
Conclusion:
CDH patients on average have lower developmental scores at 2 years of age compared to the norm. A need for ECMO, oxygen at 28 days of life, ongoing health issues and lower socioeconomic status are factors associated with developmental delays.
