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What do survivors of congenital diaphragmatic hernia look like when they grow up?
1Department of Surgery, Columbia University, New York, NY, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) survivors with congenital diaphragmatic hernia (CDH) present complex outcomes. This review examines pulmonary, cardiac, gastrointestinal, and neurocognitive issues in these children.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Developmental Pediatrics
Background:
- The advent of extracorporeal membrane oxygenation (ECMO) has increased survival rates for infants with congenital diaphragmatic hernia (CDH).
- Increased survival has revealed previously unrecognized challenges and long-term issues in CDH patients.
- There is a critical need to differentiate between CDH-specific problems and those arising from treatment interventions.
Purpose of the Study:
- To explore the multifaceted outcomes in surviving infants with congenital diaphragmatic hernia (CDH).
- To investigate whether observed problems are intrinsic to CDH or secondary to treatment modalities.
- To identify key markers for assessing long-term results in this population.
Main Methods:
- Review of existing literature and clinical data concerning congenital diaphragmatic hernia (CDH) survivors.
- Analysis of pulmonary, cardiac, gastrointestinal, and neurocognitive outcomes.
- Discussion of the potential etiologies for observed morbidities.
Main Results:
- Congenital diaphragmatic hernia (CDH) survivors exhibit a range of pulmonary complications.
- Cardiac, gastrointestinal, and neurocognitive deficits are frequently observed in this cohort.
- The interplay between the congenital defect and treatment effects requires further investigation.
Conclusions:
- Long-term management of congenital diaphragmatic hernia (CDH) requires a comprehensive approach addressing multiple organ systems.
- Distinguishing between disease-specific and treatment-related sequelae is crucial for optimizing care.
- Further research is needed to elucidate the specific contributions of CDH and its management to long-term outcomes.
Abstract:
An important consequence of the extracorporeal membrane oxygenation (ECMO) era is a renewed interest by pediatric surgeons in the infant with congenital diaphragmatic hernia (CDH). As increasing numbers of the infants survive, previously unappreciated aspects of the problem are being unmasked, provoking important questions as to their etiology. Importantly, as these children grow and develop, we must ask ourselves if their various problems are specific to CDH or are they consequences of our treatment strategies. This article considers pulmonary, cardiac, gastrointestinal, and neurocognitive markers of outcome.