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Long-term follow-up of children with congenital diaphragmatic hernia--observations from a single institution
Maria Koziarkiewicz1, Anna Taczalska1, Anna Piaseczna-Piotrowska1
1Department of Pediatric Surgery and Urology, Polish Mother's Health Center Research Institute, Lodz, Poland.
Insights
Long-term complications following congenital diaphragmatic hernia (CDH) repair include respiratory infections, GER, and growth issues. Regular follow-up with a multispecialty team is crucial for managing these sequelae in children.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Pulmonology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect requiring surgical repair.
- While many children recover well, some experience long-term health issues due to the defect and its treatment.
Purpose of the Study:
- To identify the incidence of common long-term complications after CDH repair.
- To determine risk factors associated with these complications in pediatric patients.
Main Methods:
- Clinical examination and medical record review of 50 children who underwent CDH repair.
- Utilized lung scintigraphy, spirometry, and 24-hour pH-metry for diagnostic follow-up.
Main Results:
- High incidence of recurrent respiratory infections (34%), gastrointestinal reflux (30%), and chest deformities (40%).
- Ipsilateral lung hypoplasia found in 70%; lower lung perfusion linked to negative prognostic factors like patch repair and prolonged ventilation.
- Body mass deficiency (20%) correlated with patch repair and high-frequency oscillatory ventilation (HFOV).
Conclusions:
- Common sequelae of CDH repair include respiratory infections, lung hypoplasia, GER, growth abnormalities, and skeletal deformities.
- Long-term, multidisciplinary follow-up is essential for children treated for CDH.
- Diagnostic tools like lung perfusion scintigraphy and pH-metry are vital for monitoring complications.
Introduction:
Congenital diaphragmatic hernia (CDH) is a complex malformation. The majority of children after CDH repair lead normal life, with good exercise tolerance. However, in some patients, long-term sequelae are observed, resulting from the primary defect and implemented treatment.
Material And Methods:
We evaluated (basing on clinical examination and review of medical records) the incidence of the most common long-term complications after surgical repair of CDH and determined their risk factors. The study group comprised 50 children operated in our department for CDH.
Results:
The following long-term complications were seen: recurrent respiratory system infections (34%), pathological gastrointestinal reflux (30%), body mass deficiency (20%), and chest deformations (40%). Parents reported most common symptoms from the gastrointestinal tract (48%) and recurring respiratory system infections (34%). Perfusion of the ipsilateral lung was significantly lower in the group of children in whom negative prognostic factors were present: patch repair, transposition of the liver up CDH, lung hypertension in echocardiography, high-frequency oscillatory ventilation (HFOV) use, prolonged artificial ventilation. In lung scintigraphy, in 70% of patients ipsilateral lung hypoplasia was found. There was a correlation between gastroesophageal reflux (GER) and early detection of CHD in prenatal studies and the presence of polyhydramnios. Patients with GER also required longer artificial ventilation and longer hospitalization. Significant body mass deficiency (below 3rd centile) was found in 20%, correlated with patch repair and HFOV. Chest deformations were more common in children who required synthetic patch repair and artificial ventilation for longer than 10 days.
Conclusions:
The most common long-term complications observed in children after CDH repair are recurrent infections of the respiratory tract, lung hypoplasia, pathological GER, somatic growth abnormalities, and skeletal deformations. Children operated for CDH should be followed up regularly for many years by a multispecialty medical team. Diagnostics and/or follow-up of the above complications require detailed clinical examination, lung perfusion scintigraphy, spirometry, and 24-hour pH-metry.
