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Long-term follow-up of children with diaphragmatic hernia
A Wischermann1, A M Holschneider, U Hübner
1Division of Pediatric Surgery, Children's Hospital of Cologne, Germany.
Insights
Congenital diaphragmatic hernia (CDH) repair in neonates shows good long-term outcomes. Most survivors experience no significant respiratory issues, with lung function tests revealing normal capacities and good extensibility.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Pulmonary Medicine
Background:
- Congenital diaphragmatic hernia (CDH) is a serious neonatal condition requiring surgical intervention.
- Long-term outcomes and pulmonary function in CDH survivors are crucial for understanding disease impact.
Purpose of the Study:
- To evaluate the long-term respiratory health and pulmonary function in patients who underwent operative repair for CDH.
- To identify potential long-term complications and functional deficits in CDH survivors.
Main Methods:
- Retrospective analysis of 147 neonates undergoing CDH repair between 1962 and 1988.
- Follow-up studies including clinical assessment, scintigraphic ventilation tests, and pulmonary function tests (PFTs) on survivors.
Main Results:
- 40% of 45 followed survivors were asymptomatic; 24.4% experienced increased respiratory infections, particularly in early childhood.
- Scintigraphic ventilation tests showed normal results in 77% of cases; lung function tests revealed normal vital capacity and forced expiratory volume in 29 patients.
- Some patients exhibited tendencies towards obstructive airway alterations, but overall lung extensibility was good, even in previously hypoplastic lungs.
Conclusions:
- Operative repair of CDH in neonates generally leads to favorable long-term respiratory outcomes.
- While some survivors may experience recurrent respiratory infections or mild obstructive changes, major restrictive pulmonary deficits are uncommon.
Abstract:
From 1962 to 1988, 147 neonates were admitted for operative repair of CDH to the Division of Pediatric Surgery in the Children's Hospital of Cologne. Follow-up studies were performed on 45 patients ages 1 to 25 years representing 54.2% of the 83 survivors. 18 patients (40%) were entirely without any complaints, 11 patients (24.4%) had increased rates of respiratory infections. Especially in early childhood they suffered from obstructive alterations in the respiratory tract. No restrictive pulmonary changes were observed. Scintigraphic ventilation tests were performed on 44 cases. 34 (77%) tests indicated absolutely normal results. Some rare local deficits of lung ventilation were based on adhesive anatomic alterations of the thoracic skeleton and the diaphragm. The lung function tests conducted in 29 persons ages 6 to 25 years revealed that the vital capacity and the forced expiratory volume were all normal. We found an increase of the intrathoracic gas volume in 11 infants (disposition to pulmonary inflation). In 9 cases we observed a decrease in the mid expiratory flow curves and in 6 patients we measured an increase in the specific resistance of airways (tendency towards obstructive airway alterations). Nevertheless even former hypoplastic lungs revealed a good extensibility.