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Hidden cardiovascular morbidity in children and young adults born with congenital diaphragmatic hernia: A
Katarina Övermo Tydén1, Felicia Nordenstam1, Björn Frenckner2
1Department of Women's and Children's Health, Karolinska Institutet, Sweden; Pediatric Cardiology Unit, Karolinska University Hospital, Eugeniavägen 23 C8:34, Stockholm 171 76, Sweden.
Insights
Children born with congenital diaphragmatic hernia (CDH) face significantly higher risks of cardiovascular issues later in life. Early detection and long-term monitoring are crucial for managing these long-term health complications.
Area of Science:
- Pediatric Cardiology
- Congenital Malformations
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) is a rare condition with high neonatal mortality.
- Long-term cardiovascular health in CDH survivors is not well understood.
Purpose of the Study:
- To investigate the long-term cardiovascular morbidity in children with CDH.
- To determine if CDH is a risk factor for future cardiovascular diagnoses.
Main Methods:
- Nationwide population-based prospective case-control study of Swedish children born 1982-2015.
- Five controls per patient randomly sampled.
- Cardiovascular diagnoses identified using ICD-9 and ICD-10 codes.
Main Results:
- CDH survivors had a 15-fold higher risk of cardiovascular diagnoses compared to controls (HR 15.8).
- Cardiovascular diagnoses were overrepresented in the CDH group after age one (8.0% vs 0.5%).
- Cardiac arrhythmias and hypertension diagnoses increased significantly after age one in CDH survivors.
Conclusions:
- CDH survivors experience increased cardiovascular morbidity throughout childhood and young adulthood.
- CDH is a significant risk factor for developing future cardiovascular conditions.
- Structured cardiovascular follow-up programs are essential for CDH survivors.
Introduction:
Congenital diaphragmatic (CDH) hernia is a rare congenital malformation with considerable mortality and morbidity in the neonatal period. The majority of the children today survive but little is known about long term cardiovascular morbidity.
Material And Methods:
This was a nationwide population-based prospective case-control study within a cohort of Swedish children with CDH, born 1982-2015. Five controls for each patient were randomly sampled from the population. The outcomes were the corresponding International Statistical Classification of Disease (ICD) codes for cardiovascular diagnoses according to ICD 9 and 10.
Results:
There was an overrepresentation of cardiovascular diagnoses in the CDH group after one year of age compared to the control group, 8.0vs 0.5% (n = 53 versus n = 16). The risk of having a cardiovascular diagnosis in this CDH group was 15 times higher compared to the control group (HR 15.8, 95% CI: 9-27.6, p < 0.005). The diagnoses of cardiac arrhythmias and systemic hypertension were less common in the CDH group before the age of one year compared to the CDH group beyond the age of one year. Arrhythmia 3.7 vs 15.1%, systemic hypertension 3.7 vs 7.5%.
Conclusion:
CDH survivors have increased cardiovascular morbidity during childhood and young adulthood. This implies that structured follow up programs, covering cardiovascular morbidity, needs to be developed and should be offered in pediatric and adult care. Being born with CDH seems to be a risk factor for future cardiovascular diagnoses.
Level Of Evidence:
Level 3: Case-Control Study.
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