Congenital diaphragmatic hernia and exercise capacity, a longitudinal evaluation

Area of Science:

• Pediatric Pulmonology
• Cardiopulmonary Exercise Testing
• Congenital Diaphragmatic Hernia Research

Background:

• Congenital diaphragmatic hernia (CDH) is associated with long-term pulmonary morbidity in children.
• Limited longitudinal data exists on exercise capacity in pediatric CDH survivors.
• Impaired exercise capacity is suspected in CDH patients, potentially worsening over time.

Purpose of the Study:

• To evaluate exercise capacity and its determinants in children with CDH longitudinally.
• To assess changes in exercise capacity from age 5 to 12 years in CDH patients.
• To investigate the impact of extracorporeal membrane oxygenation (ECMO) treatment on exercise capacity trends.

Main Methods:

• Prospective longitudinal follow-up study involving 114 children with CDH.
• Exercise capacity assessed using the Bruce treadmill protocol at ages 5, 8, and 12 years.
• Linear mixed models used to analyze standard deviation score (SDS) of maximal endurance time.

Main Results:

• 107 children completed 191 exercise tests; mean SDS endurance time declined significantly from -0.44 at age 5 to -1.10 at age 12 (P < 0.001).
• Exercise capacity deteriorated over time in both non-ECMO (P=0.015) and ECMO-treated (P=0.006) groups.
• Initial hospital stay duration and diffusion capacity were associated with SDS endurance time (P < 0.001 and P=0.039, respectively).

Conclusions:

• Exercise capacity in CDH patients deteriorates between ages 5 and 12, irrespective of ECMO treatment.
• CDH survivors may benefit from long-term exercise capacity assessments and timely interventions.
• Findings highlight the progressive nature of exercise limitations in pediatric CDH.