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Esophageal dilatation and reflux in neonates supported by ECMO after diaphragmatic hernia repair
C J Stolar1, W E Berdon, P W Dillon
1Division of Pediatric Surgery, Babies Hospital, Columbia Presbyterian Medical Center, New York, NY 10032.
Insights
Neonates treated with extracorporeal membrane oxygenation (ECMO) after congenital diaphragmatic hernia repair often show esophageal dilation. This finding suggests prenatal swallowing issues and significant gastroesophageal reflux in these patients.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Thoracic surgery
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring surgical repair.
- Survivors of CDH repair, particularly those requiring extracorporeal membrane oxygenation (ECMO), may experience postoperative complications.
- Esophageal abnormalities and swallowing difficulties are increasingly recognized in neonates with CDH.
Purpose of the Study:
- To investigate the incidence and significance of esophageal dilatation in neonates treated with ECMO following CDH repair.
- To explore the relationship between esophageal dilatation, swallowing function, and gastroesophageal reflux in this patient population.
- To determine if prenatal swallowing dysfunction contributes to CDH and associated hydramnios.
Main Methods:
- Retrospective analysis of 14 neonates who underwent surgical repair of CDH and received ECMO.
- Review of postoperative chest radiographs to identify esophageal dilatation.
- Assessment for gastroesophageal reflux in all patients.
Main Results:
- All 14 neonates exhibited marked esophageal dilatation on postoperative radiographs, mimicking a mediastinal mass.
- All patients subsequently demonstrated significant gastroesophageal reflux.
- Esophageal ectasia and reflux suggest a potential prenatal onset of swallowing problems.
Conclusions:
- Esophageal dilatation observed post-ECMO for CDH repair is a common finding.
- This finding is strongly associated with significant gastroesophageal reflux.
- Prenatal swallowing dysfunction may be a contributing factor to both CDH and hydramnios.
Abstract:
Extracorporeal membrane oxygenation (ECMO) for survivors of surgical repair of congenital diaphragmatic hernia was used in 14 neonates. All showed marked esophageal dilatation on postoperative chest radiographs; the dilated esophagus simulated an air- or fluid-filled mass. All patients were later shown to have marked gastroesophageal reflux as well. The finding suggests a problem in swallowing exists before birth, which may explain the recent correlation between diaphragmatic hernia and hydramnios. The observation of a mediastinal mass in neonates with congenital diaphragmatic hernia may represent esophageal ectasia and may be related to significant gastroesophageal reflux.