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Congenital diaphragmatic hernia: long-term outcome in neonates treated with extracorporeal membrane oxygenation
K P Van Meurs1, S T Robbins, V L Reed
1Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford University Medical Center, California.
Insights
Infants with congenital diaphragmatic hernia (CDH) surviving extracorporeal membrane oxygenation (ECMO) often experience growth failure and reflux. However, their neurodevelopmental and respiratory outcomes are generally good, emphasizing the need for nutritional support.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Extracorporeal Life Support
Background:
- Congenital diaphragmatic hernia (CDH) survivors treated with extracorporeal membrane oxygenation (ECMO) represent a medically complex population.
- Long-term outcomes for these infants require detailed investigation to guide clinical management.
Purpose of the Study:
- To evaluate the long-term outcomes of infants with CDH treated with postoperative ECMO.
- To identify common complications and developmental trajectories in this cohort.
Main Methods:
- Retrospective study of 18 infants with CDH treated with ECMO.
- Follow-up assessments included anthropometrics, gastroesophageal reflux evaluation, cardiac assessments, and neurodevelopmental testing.
Main Results:
- High incidence of gastroesophageal reflux (89%) and failure to thrive (50% below 5th percentile for weight at 1-2 years).
- Reherniation occurred in 22% of patients; right ventricular hypertrophy noted in 43%.
- Neurodevelopmental outcomes were comparable to other ECMO-treated children; respiratory complications were minimal.
Conclusions:
- Infants with CDH surviving ECMO demonstrate generally good health and development, with few long-term respiratory issues.
- Aggressive nutritional intervention is crucial to address prevalent growth failure.
- Close monitoring for gastroesophageal reflux and reherniation is recommended.
Abstract:
As more infants with congenital diaphragmatic hernia (CDH) survive with extracorporeal membrane oxygenation (ECMO), it seems prudent to detail the longterm outcome in these medically complex infants. Eighteen children with CDH-treated with postoperative ECMO were recruited for participation in this study. The mean duration of ECMO was 193 hours (range 82 to 493 hours), mean time to extubation after ECMO was 142 hours (range 34 to 312 hours), and median duration of hospitalization was 46 days (range 30 to 181 days). Of the 18 infants, 4 (22%) were discharged home requiring oxygen therapy. At follow-up the notable findings were a high incidence of gastroesophageal reflux and failure to thrive. At both 1 and 2 years of age, 50% of infants were at less than the 5th percentile for weight. At 1 and 2 years of age, 39% and 21%, respectively, were at less than the 5th percentile for weight/length ratio. A total of 16 children (89%) had clinical evidence of reflux, and 8 (44%) were discharged home on a regimen of nasogastric feedings. Reherniation occurred in 4 children (22%) and was more frequent when a patch was used. An electrocardiogram showed right ventricular hypertrophy in 6 (43%); oxygen saturation by pulse oximetry was > 95% in all children, and pulmonary artery pressure was estimated by Doppler echocardiography to be normal in 12 of 14 children examined. The neurodevelopmental outcome (Bayley Scales or Stanford-Binet scale) at 1 to 4 years of age was not dissimilar from that of other ECMO-treated children. Given the severity of illness in the neonatal period, the general health and development of children with CDH surviving after ECMO are good. Surprisingly few children have long-term respiratory complications related to pulmonary hypoplasia. Follow-up in the first few years should be aimed at aggressive nutritional intervention to prevent the growth failure that appears to be prevalent in these children.