Predictors for plication performance following diaphragmatic paralysis in children

Area of Science:

• Pediatric Pulmonology
• Pediatric Surgery
• Critical Care Medicine

Background:

• Diaphragmatic paralysis (DP) in children presents with varied etiologies.
• Current guidelines for selecting pediatric patients for diaphragmatic plication (DPL) are insufficient.
• Understanding risk factors for DPL is crucial for optimizing patient care.

Purpose of the Study:

• To elucidate the diverse causes of DP in pediatric patients.
• To identify risk factors and predictors for undergoing DPL in this population.
• To inform clinical decision-making for DPL in pediatric DP.

Main Methods:

• Retrospective analysis of pediatric, cardiac, and neonatal intensive care unit databases.
• Data collection spanned from 2010 to 2017 at Safra Children's Hospital.
• Patient data included diagnoses, comorbidities, and surgical interventions.

Main Results:

• DP was diagnosed in 88 pediatric patients; 59 had cardiac surgery-related etiologies.
• Patients undergoing DPL (27/88) had significant comorbidities (central nervous, respiratory, cardiovascular), higher lung injury scores, and lower weight.
• Multivariate analysis identified central nervous system (OR=9.65), respiratory (OR=4.88), and cardiovascular (OR=23.94) morbidities as independent predictors for DPL.

Conclusions:

• The etiologies of pediatric DP are highly varied.
• Comorbidities of the central nervous, respiratory, and cardiovascular systems are significant risk factors for DPL in pediatric patients with DP requiring respiratory support.
• Early consideration of DPL is recommended for these high-risk pediatric patients.