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Neurodevelopmental impairment in children with congenital diaphragmatic hernia: Not an uncommon complication for
Louise Montalva1, Gabriele Raffler1, Angela Riccio2
1Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Insights
Neurodevelopmental impairment (NDI) affects 23% of children with congenital diaphragmatic hernia (CDH). This includes motor, sensory, and cognitive deficits, with higher rates in those treated with ECMO.
Area of Science:
- Pediatric Surgery
- Neonatology
- Developmental Pediatrics
Background:
- Congenital diaphragmatic hernia (CDH) is a complex birth defect with significant long-term implications.
- Neurodevelopmental impairment (NDI) is a recognized complication in survivors, impacting various developmental domains.
Purpose of the Study:
- To systematically evaluate the incidence, types, and predictors of NDI in children with CDH.
- To synthesize existing evidence on neurodevelopmental outcomes in the CDH population.
Main Methods:
- A systematic review and meta-analysis were conducted.
- Searched for studies reporting NDI incidence, types, neuroimaging findings, and risk factors in CDH patients.
- Utilized RevMan 5.3 for meta-analysis of comparative studies.
Main Results:
- Out of 3541 CDH children across 33 studies, 23% (829) exhibited NDI.
- ECMO treatment was associated with a higher NDI incidence (49%) compared to non-ECMO (22%).
- NDI spectrum included hypotonia (42%), hearing (13%), visual (8%), neurobehavioral (20%), and learning difficulties (31%). Abnormal neuroimaging occurred in 49% of 288 survivors.
Conclusions:
- NDI is a significant concern, affecting approximately 1 in 4 CDH survivors.
- The impairment spans motor, sensory, cognitive, language, and behavioral domains.
- Further research is needed to understand NDI pathophysiology and identify modifiable risk factors for better long-term outcomes.
Purpose:
To evaluate neurodevelopmental impairment (NDI) in children born with congenital diaphragmatic hernia (CDH).
Methods:
Using a defined search strategy, a systematic review was conducted to define the incidence and types of NDI, to report abnormal neuroimaging findings and to evaluate possible NDI predictors. A meta-analysis was performed on comparative studies reporting risk factors for NDI, using RevMan 5.3.
Results:
Of 3541 CDH children (33 studies), 829 (23%) had NDI, with a higher incidence in CDH survivors who received ECMO treatment (49%) vs. those who had no ECMO (22%; p<0.00001). NDI included neuromuscular hypotonia (42%), hearing (13%) and visual (8%) impairment, neurobehavioral issues (20%), and learning difficulties (31%). Of 288 survivors that had postnatal neuroimaging, 49% had abnormal findings. The main risk factors for NDI were severe pulmonary hypoplasia, large defect size, ECMO use.
Conclusions:
NDI is a relevant problem for CDH survivors, affecting 1 in 4. The spectrum of NDI covers all developmental domains and ranges from motor and sensory (hearing, visual) deficits to cognitive, language, and behavioral impairment. Further studies should be designed to better understand the pathophysiology of NDI in CDH children and to longitudinally monitor infants born with CDH to correct risk factors that can be modifiable.
Level Of Evidence:
Level III.
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