Related Experiment Video
Updated: Feb 18, 2026
Transuterine Fetal Tracheal Occlusion Model in Mice
Published on: February 5, 2021
Diaphragmatic function in infants and children with congenital diaphragmatic hernia: a cross-sectional study
Sonia Khirani1,2, Alessandro Amaddeo2,3, Naziha Khen-Dunlop3,4
1ASV Santé, Gennevilliers, France.
Insights
Infants with congenital diaphragmatic hernia (CDH) experience diaphragmatic dysfunction that improves with age. This dysfunction, assessed via esophageal and gastric pressure recordings, correlates with antenatal pulmonary volume but normalizes by age five.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Neonatology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition affecting infant respiratory function.
- Long-term diaphragmatic function following surgical repair in CDH patients is not well understood.
- Assessing diaphragmatic function is crucial for understanding long-term outcomes in CDH survivors.
Purpose of the Study:
- To evaluate diaphragmatic function in infants and young children after surgical repair of congenital diaphragmatic hernia (CDH).
- To assess the long-term effects of CDH on diaphragmatic strength and endurance.
- To identify potential correlations between antenatal factors and postnatal diaphragmatic function.
Main Methods:
- A cross-sectional study involving 28 infants and children with CDH post-surgical repair.
- Diaphragmatic function assessed using esophageal and gastric pressure recordings (Pgas) at different time points: before hospital discharge (Y0), around 1 year (Y1), and around 5 years (Y5).
- Measurements included transdiaphragmatic pressure for strength and diaphragmatic tension time index (TTdi) for endurance.
Main Results:
- Diaphragmatic strength was low at Y0 but normalized by Y5.
- Diaphragmatic dysfunction (assessed by Pgas) was present at Y0 and Y1, with improvement but persistence at Y5.
- High neonatal TTdi (diaphragmatic endurance) correlated negatively with antenatal estimated pulmonary volume (VLA).
Conclusions:
- Infants with CDH exhibit diaphragmatic dysfunction in the neonatal period, which improves with age.
- The degree of diaphragmatic dysfunction correlates with antenatal pulmonary volume.
- Further longitudinal studies are recommended to explore factors like CDH side and repair method.
Objectives:
Few studies have evaluated long-term diaphragmatic function in congenital diaphragmatic hernia (CDH). The aim of our cross-sectional study was to assess diaphragmatic function in infants and young children with CDH after surgical repair.
Methods:
All the patients with CDH repair followed in our centre between February 2014 and January 2016 were enrolled. Patients with a postnatal diagnosis after 1 month of life were excluded. Breathing pattern and diaphragmatic function were assessed using esophageal and gastric (Pgas) pressure recording after surgery, or at 1 or 5 years of age.
Results:
Twenty-eight patients (24 left-sided CDH, 6 with diaphragmatic patch) were included. Twelve patients were assessed before hospital discharge (Y0), 6 around the age of 1 year (Y1) and 10 around the age of 5 years (Y5). Mean antenatal estimated pulmonary volume (VLA) was 42 ± 10% (n = 23). Diaphragmatic strength, assessed by transdiaphragmatic pressure during crying/sniff, was low at Y0 (47 ± 18 cmH2O, n = 12) and within normality at Y5 (81 ± 15 cmH2O, n = 7). Diaphragmatic dysfunction, assessed by Pgas during crying/sniff, was present at Y0 (-58 ± 22 cmH2O, n = 12) and Y1 (-53 ± 36 cmH2O, n = 5) and still present at Y5 (3 ± 9 cmH2O, n = 7) but to a lesser extent. The diaphragmatic tension time index (TTdi), which estimates diaphragmatic endurance, was high at Y0 (0.10 ± 0.04, n = 11) and within normality at Y5 (0.03 ± 0.01, n = 6). VLA correlated with neonatal TTdi (r = -0.961, P < 0.001).
Conclusions:
Infants with CDH have diaphragmatic dysfunction in the neonatal period, which correlates with VLa and normalizes with age. Future longitudinal studies should assess the role of CDH side, size of diaphragmatic defect and patch repair.
