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Prenatal Imaging Features and Postnatal Factors Associated with Gastrointestinal Morbidity in Congenital
Mariatu A Verla1, Candace C Style1, Amy R Mehollin-Ray2
1Texas Children's Fetal Center, Texas Children's Hospital and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Insights
Infants with congenital diaphragmatic hernia (CDH) and large defects requiring mechanical ventilation or ECMO face higher risks of gastrointestinal issues like GERD and gastroparesis. Prenatal imaging showing stomach displacement indicates increased GI morbidity.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Medicine
Background:
- Congenital diaphragmatic hernia (CDH) is a complex condition requiring multidisciplinary care.
- Postnatal gastrointestinal (GI) morbidity is a significant concern for CDH survivors.
- Identifying predictive factors for GI complications is crucial for improving patient outcomes.
Purpose of the Study:
- To comprehensively assess postnatal GI morbidity in CDH patients.
- To determine prenatal imaging features associated with GI complications.
- To identify postnatal factors contributing to GI morbidity in CDH.
Main Methods:
- Retrospective review of 256 infants evaluated for CDH from 2004-2017.
- Analysis of prenatal imaging and postnatal variables.
- Statistical analysis including Mann-Whitney U, Kruskal-Wallis, and logistic regression.
Main Results:
- 60% of CDH survivors experienced GERD, 13% gastroparesis, 32% required a G-tube, and 17% needed fundoplication.
- Large defects, patch repair, ECMO, and prolonged ventilation correlated with increased GI morbidity.
- Significant stomach displacement (grades 3-4) on prenatal imaging predicted higher GERD, G-tube need, and supplemental nutrition requirements.
Conclusions:
- CDH survivors with large defects, prolonged ventilation, or ECMO are at increased risk for GERD, gastroparesis, and major GI surgery.
- Prenatal imaging findings, particularly stomach displacement, are significant predictors of GI morbidity in left-sided CDH.
- Early identification of at-risk infants can guide proactive GI management strategies.
Background:
To perform a comprehensive assessment of postnatal gastrointestinal (GI) morbidity and determine the prenatal imaging features and postnatal factors associated with its development in patients with congenital diaphragmatic hernia (CDH).
Materials And Methods:
A retrospective review was conducted of all infants evaluated for CDH at a quaternary fetal center from February 2004 to May 2017. Prenatal imaging features and postnatal variables were analyzed. GI morbidity was the primary outcome. The Mann-Whitney U test, the Kruskal-Wallis test with Dunnett's T3 post hoc analysis and logistic regression, and the χ2 test were performed when appropriate.
Results:
We evaluated 256 infants; 191 (75%) underwent CDH repair and had at least 6 months of follow-up. Of this cohort, 60% had gastroesophageal reflux disease (GERD), 13% had gastroparesis, 32% received a gastrostomy tube (G-tube), and 17% needed a fundoplication. Large defect, patch repair, extracorporeal membrane oxygenation (ECMO), and prolonged use of mechanical ventilation were significantly associated with having GERD, gastroparesis, G-tube placement, and fundoplication (p < 0.05). Fetuses with stomach grades 3 and 4 were most likely to have GERD, a G-tube, and a long-term need for supplemental nutrition than fetuses with stomach grades 1 and 2 (p < 0.05).
Conclusion:
Survivors of CDH with large defects, prolonged use of mechanical ventilation, or that have received ECMO may be at an increased risk for having GERD, gastroparesis, and major GI surgery. Marked stomach displacement on prenatal imaging is significantly associated with GI morbidity in left-sided CDH.
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