Long-term neurodevelopmental outcomes of congenital diaphragmatic hernia survivors not treated with extracorporeal membrane oxygenation

• Published in: Journal of pediatric surgery 2011-07, Vol.46 (7), p.1309-1318
• Main Authors: Frisk, Virginia, Jakobson, Lorna S, Unger, Sharon, Trachsel, Daniel, O'Brien, Karel
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - etiology; Brain Damage, Chronic - epidemiology; Brain Damage, Chronic - etiology; Brain Damage, Chronic - prevention & control; Child; Cognitive; Congenital diaphragmatic hernia; Developmental Disabilities - epidemiology; Developmental Disabilities - etiology; Developmental Disabilities - prevention & control; Educational Status; Extracorporeal membrane oxygenation (ECMO); Extracorporeal Membrane Oxygenation - utilization; Follow-Up Studies; Hernia, Diaphragmatic - surgery; Hernias, Diaphragmatic, Congenital; High-Frequency Ventilation; Humans; Hypocapnia - complications; Hypocapnia - prevention & control; Infant, Newborn; Intelligence; Intraoperative Complications; Language Disorders - epidemiology; Language Disorders - etiology; Learning disabilities; Learning Disorders - epidemiology; Learning Disorders - etiology; Learning Disorders - prevention & control; Memory Disorders - epidemiology; Neurodevelopmental; Ontario - epidemiology; Outcome; Pediatrics; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Psychometrics; Social Behavior Disorders - epidemiology; Social Behavior Disorders - etiology; Surgery; Surveys and Questionnaires
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.12.023

Abstract Background/Purpose Although there has been a marked improvement in the survival of children with congenital diaphragmatic hernia (CDH) in the past 2 decades, there are few reports of long-term neurodevelopmental outcome in this population. The present study examined neurodevelopmental outcomes in 10- to 16-year-old CDH survivors not treated with extracorporeal membrane oxygenation (ECMO). Methods Parents of 27 CDH survivors completed questionnaires assessing medical problems, daily living skills, educational outcomes, behavioral problems, and executive functioning. Fifteen CDH survivors and matched full-term controls completed standardized intelligence, academic achievement, phonological processing, and working memory tests. Results Non–ECMO-treated CDH survivors demonstrated high rates of clinically significant difficulties on standardized academic achievement measures, and 14 of the 27 survivors had a formal diagnosis of specific learning disability, attention deficit hyperactivity disorder, or developmental disability. Specific problems with executive function, cognitive and attentional weaknesses, and social difficulties were more common in CDH patients than controls. Perioperative hypocapnia was linked to executive dysfunction, behavioral problems, lowered intelligence, and poor achievement in mathematics. Conclusions Non–ECMO-treated CDH survivors are at substantial risk for neurodevelopmental problems in late childhood and adolescence.