Long term follow-up in high-risk congenital diaphragmatic hernia survivors: patching the diaphragm affects the outcome

• Published in: Journal of pediatric surgery 2011, Vol.46 (1), p.52-56
• Main Authors: Valfrè, Laura, Braguglia, Annabella, Conforti, Andrea, Morini, Francesco, Trucchi, Alessandro, Iacobelli, Barbara Daniela, Nahom, Antonella, Chukhlantseva, Natalia, Dotta, Andrea, Corchia, Carlo, Bagolan, Pietro
• Format: Article
• Language: English
• Subjects: Chest wall deformities; Child, Preschool; Congenital diaphragmatic hernia; Diaphragm - abnormalities; Diaphragm - pathology; Diaphragm - surgery; Female; Follow-up; Gastroesophageal reflux; Gastroesophageal Reflux - surgery; Growth; Hernia, Diaphragmatic - mortality; Hernia, Diaphragmatic - pathology; Hernia, Diaphragmatic - surgery; Hernias, Diaphragmatic, Congenital; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Patch repair; Pediatrics; Risk Factors; Surgery; Survival Rate; Survivors; Thoracic Wall - abnormalities; Thoracic Wall - surgery; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.09.061

Abstract Background/Purpose The increased survival rate reached in infants with congenital diaphragmatic hernia (CDH) has shown a concomitant increase in late morbidity. A recent report from CDH Study Group showed that dimension of diaphragmatic defect is the only independent risk factor of mortality. However, the influence of defect size on late morbidity is still controversial. The aim of the study was to evaluate the influence of patch repair (proxy of diaphragmatic defects size) on midterm morbidity. Methods All high-risk (prenatal diagnosis and/or respiratory symptoms within 6 hours of life) CDH survivors treated at our institution from 2004 to 2008 were followed up in a multidisciplinary outpatient clinic as part of a longitudinal prospective study. Auxological, gastroesophageal, pulmonary, and orthopedic evaluations were performed at 6, 12, and 24 months of age. Patient outcomes were compared with respect to +/− patch repair. Results Of 70 survivors, 61 (87%) were enrolled and prospectively evaluated in follow-up. Poorer auxological outcome, increased rate of gastroesophageal reflux, and altered pulmonary function test were observed during follow-up. Conclusions Patch repair correlates with higher pulmonary, auxological, and gastroesophageal morbidity without increasing chest wall deformities at long-term follow-up.