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Computed Tomographic Study of the Pediatric Diaphragmatic Growth: Application to the Treatment of Congenital
Anne Schneider1, Meriam Koob2, Nicolas Sananes3
1Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France.
Insights
Current congenital diaphragmatic hernia (CDH) prostheses lack elasticity and do not adapt to child growth. This study quantines diaphragmatic growth, revealing a mean growth factor of 4-5, crucial for developing improved CDH prostheses.
Area of Science:
- Biomedical Engineering
- Pediatric Surgery
- Medical Imaging
Background:
- Congenital diaphragmatic hernia (CDH) treatment often uses inelastic prostheses that fail to match diaphragm mechanics or pediatric growth.
- This limitation contributes to high recurrence rates, highlighting the need for better prosthetic solutions.
Purpose of the Study:
- To determine the essential properties for novel prostheses by quantifying diaphragmatic growth in children.
- To compare two methods for estimating diaphragmatic surface area from CT scans.
Main Methods:
- Thoracoabdominal CT scans from 18 healthy children (divided into two age groups) were analyzed.
- Two methods were used: 2D surface estimation (method 1) and length measurements (method 2) to calculate diaphragmatic surface area.
- Statistical comparison of the methods and calculation of the growth factor between age groups.
Main Results:
- A significant difference was found between the two methods for calculating diaphragmatic surface area (p=0.022 left, p=0.002 right), indicating they are not interchangeable.
- The mean diaphragmatic surface growth factor from early childhood to adolescence was approximately 4 to 5.
- Method 2 showed higher growth ratios (5.1) compared to Method 1 (4.3 left, 4.0 right).
Conclusions:
- Precise estimation of diaphragmatic surface area is critical for developing effective CDH prostheses.
- The study identified a mean diaphragmatic growth factor of 4-5, providing essential data for designing elastic, growth-accommodating prostheses.
- Further research into developing improved prosthetic materials for CDH is warranted.
Abstract:
Background The prosthesis commonly used for the treatment of congenital diaphragmatic hernia (CDH) lacks elasticity to replace the diaphragm's mechanical properties and does not follow the natural growth of the child treated. Objective To determine the appropriate properties required for the prostheses, a CT study on healthy patients was conducted. Methods Two methods of diaphragmatic surface analysis are assessed: the diaphragmatic surface is either estimated using surface 2D estimations (method 1), or calculated using length measures on thoracoabdominal CT scans from children (method 2). Patients are divided into two groups depending on their age: group 1: n = 9; median age: 2.0 months (0.1-9.5); group 2: n = 9; median age: 182.6 months (158.5-235.5). Growth factor between the two groups is calculated and the two methods are statistically compared. Results The ratio group 2/group 1 of the diaphragmatic surfaces was 4.3 ± 0.2 on the left side and 4.0 ± 0.2 on the right side for method 1, and 5.1 ± 0.2 on the left side and 5.1 ± 0.3 on the right side for method 2. The difference in the median values between both methods is statistically significant for both the left and right sides (p = 0.022 and p = 0.002, respectively). Hence, the two methods cannot be used exchangeably. Conclusion The treatment of CDH with large defect remains a challenge because of the high incidence of hernia recurrence probably due to prosthesis defect; thus it is important to estimate the diaphragmatic surface precisely. We aim to develop a prosthesis material that can be commonly used and found a mean diaphragmatic growth factor of approximately 4 to 5 from early childhood to adolescence.
