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Leyens J, Bo B, Heydweiller A, Schaible T, Boettcher M, Schroeder L, Mueller A, Kipfmueller F. Parents-reported nutrition and feeding difficulties in infants with congenital diaphragmatic hernia after hospital discharge. Early Hum Dev 2024; 195:106074. [PMID: 39024811 DOI: 10.1016/j.earlhumdev.2024.106074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/20/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Congenital diaphragmatic hernia (CDH) affects 1 in 3000-5000 newborns. In survivors, long-term complications include gastroesophageal reflux (GER), feeding difficulties, and failure to thrive. Data from the parents' perspective remain scarce. This study aims to report the prevalence and impact of feeding difficulties on CDH families after discharge. METHODS National web-based survey amongst families with CDH infants in 2021. RESULTS Caregivers of 112 CDH survivors participated. The baseline characteristics were representative with 54 % male, 83 % left-sided CDH, prenatal diagnosis in 83 %, and 34 % requiring extracorporeal membrane oxygenation. Most infants (81 %) were discharged within three months, with 62 % feeding by mouth, and 30 % requiring a feeding tube. Persisting feeding difficulties were experienced by 73 %, GER being the most common (66 %), followed by insufficient weight gain (64 %). After discharge, 41 % received medical support for failure to thrive. The primary-care pediatrician was consulted most frequently for information (61 %) and treatment of feeding difficulties (74 %). Therapeutic success was reported in 64 %. A cessation of symptoms was achieved in 89 % within three years. CONCLUSION The majority of CDH infants had persistent feeding difficulties. This survey highlights the impact surrounding feeding problems on CDH families. Further studies and support systems are needed to raise the quality of life in CDH infants and their families.
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Affiliation(s)
- Judith Leyens
- Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany.
| | - Bartolomeo Bo
- Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany
| | - Andreas Heydweiller
- Division of Pediatric Surgery, Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Germany
| | - Thomas Schaible
- Department of Neonatology, University Medical Center Mannheim, Heidelberg University, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Germany
| | - Lukas Schroeder
- Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany
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2
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King S, Carr BDE, Mychaliska GB, Church JT. Surgical approaches to congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151441. [PMID: 38986242 DOI: 10.1016/j.sempedsurg.2024.151441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Surgical repair of the diaphragm is essential for survival in congenital diaphragmatic hernia (CDH). There are many considerations surrounding the operation - why the operation matters, optimal timing of repair and its relation to extracorporeal life support (ECLS) use, minimally invasive versus open approaches, and strategies for reconstruction. Surgery is both affected by, and affects, the physiology of these infants and is an important factor in determining long-term outcomes. Here we discuss the evidence and provide insight surrounding this complex decision making, technical pearls, and outcomes in repair of CDH.
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Affiliation(s)
- Sarah King
- C.S. Mott Children's Hospital, Section of Pediatric Surgery, Department of Surgery, University of Michigan. Ann Arbor, MI, USA
| | - Benjamin D E Carr
- Doernbecher Children's Hospital, Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University. Portland, OR, USA
| | - George B Mychaliska
- C.S. Mott Children's Hospital, Section of Pediatric Surgery, Department of Surgery, University of Michigan. Ann Arbor, MI, USA
| | - Joseph T Church
- C.S. Mott Children's Hospital, Section of Pediatric Surgery, Department of Surgery, University of Michigan. Ann Arbor, MI, USA.
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Pollack JC, Hollinger LE, Buchmiller TL, Jancelewicz T. Long-term follow-up in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151443. [PMID: 38972214 DOI: 10.1016/j.sempedsurg.2024.151443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
With improvements in initial care for patients with congenital diaphragmatic hernia (CDH), the number of CDH patients with severe disease who are surviving to discharge has increased. This growing population of patients faces a unique set of long-term challenges, multisystem adverse outcomes, and post-intervention complications requiring specialized multidisciplinary follow-up. Early identification and intervention are essential to mitigate the potential morbidity associated with these challenges. This manuscript outlines a general framework for long-term follow-up for the CDH patient, including cardiopulmonary, gastrointestinal, neurodevelopmental, surgical, and quality of life outcomes.
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Affiliation(s)
- Jessica C Pollack
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, USA; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - Laura E Hollinger
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, USA
| | | | - Tim Jancelewicz
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, USA.
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Pulvirenti R, IJsselstjin H, Mur S, Morini F. Approaches to nutrition and feeding in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151442. [PMID: 39004036 DOI: 10.1016/j.sempedsurg.2024.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In patients with congenital diaphragmatic hernia1, nutrition can represent a challenge both in the short and long term. Its failure to resolve can have a significant impact on multiple aspects of the lives of patients with congenital diaphragmatic hernia (CDH), ranging from lung function to neurodevelopment. In this review, we will describe the causes of nutritional problems in patients with CDH, their consequences, and possible strategies to address them.
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Affiliation(s)
- Rebecca Pulvirenti
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands; Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Hanneke IJsselstjin
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sebastien Mur
- Department of Neonatology, Lille University Hospital, French CDH reference center, Lille, France
| | - Francesco Morini
- Department of Maternal, Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
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5
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Sloan P, Johng S, Daniel JM, Rhee CJ, Mahmood B, Gravari E, Marshall S, Downey AG, Braski K, Gowda SH, Fernandes CJ, Dariya V, Haberman BE, Seabrook R, Makkar A, Gray BW, Cookson MW, Najaf T, Rintoul N, Hedrick HL, DiGeronimo R, Weems MF, Ades A, Chapman R, Grover TR, Keene S. A clinical consensus guideline for nutrition in infants with congenital diaphragmatic hernia from birth through discharge. J Perinatol 2024; 44:694-701. [PMID: 38627594 DOI: 10.1038/s41372-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To develop a consensus guideline to meet nutritional challenges faced by infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN The CDH Focus Group utilized a modified Delphi method to develop these clinical consensus guidelines (CCG). Topic leaders drafted recommendations after literature review and group discussion. Each recommendation was sent to focus group members via a REDCap survey tool, and members scored on a Likert scale of 0-100. A score of > 85 with no more than 25% outliers was designated a priori as demonstrating consensus among the group. RESULTS In the first survey 24/25 recommendations received a median score > 90 and after discussion and second round of surveys all 25 recommendations received a median score of 100. CONCLUSIONS We present a consensus evidence-based framework for managing parenteral and enteral nutrition, somatic growth, gastroesophageal reflux disease, chylothorax, and long-term follow-up of infants with CDH.
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Affiliation(s)
- Patrick Sloan
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110-1093, USA.
| | - Sandy Johng
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - John M Daniel
- Department of Pediatrics, Division of Neonatology, University of Missouri Kansas School of Medicine, Kansas City, MO, USA
| | - Christopher J Rhee
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Burhan Mahmood
- Department of Pediatrics, Division of Newborn Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Evangelia Gravari
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Ann G Downey
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Katie Braski
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sharada H Gowda
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Vedanta Dariya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Beth E Haberman
- Department of Pediatrics, Division of Neonatology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ruth Seabrook
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Abhishek Makkar
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian W Gray
- Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Michael W Cookson
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Tasnim Najaf
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110-1093, USA
| | - Natalie Rintoul
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Holly L Hedrick
- Department of Pediatric General Thoracic and Fetal Surgery Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert DiGeronimo
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Mark F Weems
- Division of Neonatology and Le Bonheur Children's Hospital, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anne Ades
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Chapman
- Department of Pediatrics, USC Keck School of Medicine, Fetal & Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Theresa R Grover
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah Keene
- Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Cimbak N, Buchmiller TL. Long-term follow-up of patients with congenital diaphragmatic hernia. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000758. [PMID: 38618013 PMCID: PMC11015326 DOI: 10.1136/wjps-2023-000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/16/2024] Open
Abstract
Neonates with congenital diaphragmatic hernia encounter a number of surgical and medical morbidities that persist into adulthood. As mortality improves for this population, these survivors warrant specialized follow-up for their unique disease-specific morbidities. Multidisciplinary congenital diaphragmatic hernia clinics are best positioned to address these complex long-term morbidities, provide long-term research outcomes, and help inform standardization of best practices in this cohort of patients. This review outlines long-term morbidities experienced by congenital diaphragmatic hernia survivors that can be addressed in a comprehensive follow-up clinic.
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Affiliation(s)
- Nicole Cimbak
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Terry L Buchmiller
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA, USA
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Coignard M, Mellul K, Stirnemann J, Khen-Dunlop N, Lapillonne A, Kermorvant-Duchemin E. First-year growth trajectory and early nutritional requirements for optimal growth in infants with congenital diaphragmatic hernia: a retrospective cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:166-172. [PMID: 37666658 DOI: 10.1136/archdischild-2023-325713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To describe the growth trajectory of children with congenital diaphragmatic hernia (CDH) during the first year, to assess the risk factors for growth failure (GF) at 1 year and to determine nutritional intakes at discharge required for early optimal growth. DESIGN Single-centre retrospective cohort study based on data from a structured follow-up programme. SETTING AND PATIENTS All neonates with CDH (2013-2019) alive at discharge and followed up to age 1. INTERVENTIONS None. MAIN OUTCOME MEASURES Weight-for-age z-score (WAZ) at birth, 3, 6 and 12 months of age; risk factors for GF at age 1; energy and protein intake of infants achieving early optimal growth. RESULTS Sixty-three of 65 neonates who were alive at discharge were included. Seven (11%) had GF at 1 year and 3 (4.8%) had a gastrostomy tube. The mean WAZ decreased in the first 3 months before catching up at 1 year (-0.6±0.78). Children with a severe form or born preterm experienced a deeper loss (from -1.5 to -2 z-scores) with late and limited catch-up. The median energy intake required to achieve positive or null weight growth velocity differed significantly according to CDH severity, ranging from 100 kcal/kg/day (postnatal forms) to 139 kcal/kg/day (severe prenatal forms) (p=0.009). CONCLUSIONS Growth patterns of CDH infants suggest that nutritional risk stratification and feeding practices may influence growth outcomes. Our results support individualised and active nutritional management based on CDH severity, with energy requirements as high as 140% of recommended intakes for healthy term infants.
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Affiliation(s)
- Maxime Coignard
- Department of Neonatal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Kelly Mellul
- Department of Neonatal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Julien Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Naziha Khen-Dunlop
- Department of Paediatric Surgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Alexandre Lapillonne
- Department of Neonatal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatal Medicine, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
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Orlinsky R, Land S, Flohr S, Rintoul N, Goldshore M, Hedrick HL. Birth Admission Length-of-Stay and Hospital Readmission in Children With Congenital Diaphragmatic Hernia. J Pediatr Surg 2023; 58:2368-2374. [PMID: 37659921 DOI: 10.1016/j.jpedsurg.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The objective of this study was to identify factors associated with prolonged birth admission length of stay (LOS) and to evaluate the association between these characteristics and readmission in the year following discharge for children with congenital diaphragmatic hernia (CDH). METHODS This was a single-center retrospective cohort study of children with isolated CDH born in the Special Delivery Unit and admitted to the Newborn/Infant Intensive Care Unit at Children's Hospital of Philadelphia from April 2008 to August 2019. Birth admission hospitalization was categorized into 3 groups (≤35, 36-75, and >76 days) based on the data distribution. Participant factors included gestational age (days), side of CDH (right/left), liver position (up/down), CDH repair technique (open/minimally invasive), exposure to extracorporeal membrane oxygenation, lung-to-head circumference ratio, and feeding tube at discharge. Chi-squared, t-tests and analysis of variance were used to examine bivariable associations between participant characteristics, birth admission LOS and readmission in the year following initial hospital discharge. Multivariable logistic regression was used to evaluate factors associated with readmission. RESULTS Children hospitalized ≥76 days at birth had 4.33 (95% CI: 1.2, 15.2) higher odds of readmission than those admitted for ≤35 days. Children with a non-operative feeding tube at discharge had 4.12 (895% CI: 1.6, 10.5) higher odds of readmission when compared to those with no feeding tube at discharge. CONCLUSIONS Longer birth hospitalization and non-operative feeding tube are associated with increased readmissions in the year after discharge. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Rachel Orlinsky
- Richard D. Wood Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA; University of Maryland Medical Center, Baltimore, MD, USA
| | - Sierra Land
- Richard D. Wood Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA.
| | - Sabrina Flohr
- Richard D. Wood Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA
| | - Natalie Rintoul
- Division of Neonatology, Children's Hospital of Philadelphia, PA, USA
| | - Matthew Goldshore
- Richard D. Wood Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA
| | - Holly L Hedrick
- Richard D. Wood Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, PA, USA
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Herranz Barbero A, Iglesias-Platas I, Prat-Ortells J, Clotet Caba J, Moreno Hernando J, Castañón García-Alix M, Pertierra Cortada Á. Transpyloric Tube Placement Shortens Time to Full Feeding in Left Congenital Diaphragmatic Hernia. J Pediatr Surg 2023; 58:2098-2104. [PMID: 37507336 DOI: 10.1016/j.jpedsurg.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Nutritional complications have an impact in both short- and long-term morbidity of patients with congenital diaphragmatic hernia (CDH). We aimed to compare time to full enteral tube feeding depending on route -gastric (GT) or transpyloric (TPT)- in newborns with left CDH (L-CDH). METHODS Retrospective cohort study of L-CDH patients admitted to a referral tertiary care NICU between January 2007 and December 2014. Lethal chromosomal abnormalities and death before initiation of enteral nutrition were exclusion criteria. RESULTS 37 patients were fed through GT, 46 by TPT. TPT children took 11.0 (6.8) days to reach full enteral tube feeding and spent 16.6 (8.1) days on parenteral nutrition vs 16.8 (14.7) days (p = 0.041) and 22.7 (13.5) days (p = 0.020) of GT patients. TPT children had 3.9 (2.4) days of fasting due to GI issues and 20% had episodes of decreased rates of enteral nutrition for extra-GI complications vs 11.4 (11.1) days (p = 0.028) and 49% (p = 0.006). According to the best fitting model (R2 0.383, p < 0.001), the TPT-group achieved full enteral feeding 8.4 days earlier than the GT-group (95% CI -14.76 to - 2.02 days), after adjustment by severity of illness during the first days, o/e LHR_liver and class of diaphragmatic defect. There were no differences in growth outcomes and length of stay between survivors of GT and TPT groups. CONCLUSION TPT shortens time to full enteral nutrition, especially in the most severe L-CDH patients. We propose that placement of a TPT at the end of the surgical repair procedure should be considered, especially in higher-risk patients. LEVEL OF EVIDENCE Treatment study, Level III. Retrospective comparative, case-control study.
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Affiliation(s)
- Ana Herranz Barbero
- Neonatology Department, Hospital Clínic, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.
| | - Isabel Iglesias-Platas
- Neonatology Department, Hospital Sant Joan de Deu, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, Pg. Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi Prat-Ortells
- Pediatrics Surgery Department, Hospital Sant Joan de Deu, University of Barcelona, Pg. Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi Clotet Caba
- Neonatology Department, Hospital Sant Joan de Deu, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, Pg. Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Julio Moreno Hernando
- Neonatology Department, Hospital Sant Joan de Deu, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, Pg. Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Montserrat Castañón García-Alix
- Pediatrics Surgery Department, Hospital Sant Joan de Deu, University of Barcelona, Pg. Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - África Pertierra Cortada
- Neonatology Department, Hospital Sant Joan de Deu, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, Pg. Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
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10
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Bourezma M, Mur S, Storme L, Cailliau E, Vaast P, Sfeir R, Lauriot Dit Prevost A, Aubry E, Le Duc K, Sharma D. Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia. J Clin Med 2023; 12:jcm12062415. [PMID: 36983415 PMCID: PMC10059888 DOI: 10.3390/jcm12062415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral feeding autonomy in patients treated for CDH. METHODS This monocentric cohort study included 138 patients with CDH. Eighty-four patients were analyzed after the exclusion of 54 patients (11 with delayed postnatal diagnosis, 5 with chromosomal anomaly, 9 with genetic syndrom, 13 with right-sided CDH, and 16 who died before discharge and before oral feeding autonomy was acquired). They were divided into two groups: oral feeding autonomy at initial hospital discharge (group 1, n = 51) and nutritional support at discharge (group 2, n = 33). Antenatal, postnatal, and perisurgical data were analyzed from birth until first hospital discharge. To remove biased or redundant factors related to CDH severity, statistical analysis was adjusted according to the need for a patch repair. RESULTS After analysis and adjustment, delayed oral feeding autonomy was not related to observed/expected lung-to-head ratio (LHR o/e), intrathoracic liver and/or stomach position, or operative duration. After adjustment, prophylactic gastrostomy (OR adjusted: 16.3, IC 95%: 3.6-74.4) and surgical reoperation (OR adjusted: 5.1, IC 95% 1.1-23.7) remained significantly associated with delayed oral feeding autonomy. CONCLUSIONS Delayed oral feeding autonomy occurred in more than one third of patients with CDH. Both prophylactic gastrostomy and surgical reoperation represent significant risk factors. Bowel obstruction might also impact oral feeding autonomy. Prophylactic gastrostomy seems to be a false "good idea" to prevent failure to thrive. This procedure should be indicated case per case. Bowel obstruction and all surgical reoperations represent decisive events that could impact oral feeding autonomy.
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Affiliation(s)
- Mélina Bourezma
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Sébastien Mur
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Laurent Storme
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Emeline Cailliau
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
- Biostatistics Department, CHU Lille, FR-59000 Lille, France
| | - Pascal Vaast
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- CHU Lille, Clinic of Obstetrics and Gynaecology, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Rony Sfeir
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | | | - Estelle Aubry
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Kévin Le Duc
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Dyuti Sharma
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
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11
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Long-Term Evaluation of Gastroesophageal Reflux in Neonates with and without Preventive Anti-reflux Surgery at the Time of Congenital Diaphragmatic Hernia Repair. CHILDREN 2022; 9:children9081137. [PMID: 36010028 PMCID: PMC9406490 DOI: 10.3390/children9081137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022]
Abstract
One potential comorbidity after congenital diaphragmatic hernia (CDH) is gastroesophageal reflux (GER), which can have a substantial effect on patients’ quality of life, thriving, and complications later in life. Efforts have been made to reduce gastroesophageal reflux with a preventive anti-reflux procedure at the time of CDH repair. In this follow-up study of neonates participating in a primary RCT study on preventive anti-reflux surgery, symptoms of GER were assessed longitudinally. Long-term data with a median follow-up time of ten years was available in 66 patients. Thirty-one neonates received an initial fundoplication. Secondary anti-reflux surgery was necessary in 18% and only in patients with large defects. It was required significantly more often in patients with intrathoracic herniation of liver (p = 0.015) and stomach (p = 0.019) and patch repair (p = 0.03). Liver herniation was the only independent risk factor identified in multivariate regression analysis. Primary fundopexy and hemifundoplication did not reveal a protective effect regarding the occurrence of GER symptoms, the need for secondary antireflux surgery or the gain of body weight regardless of defect size neither in the short nor in the long term. Symptoms of GER must be assessed carefully especially in children with large defects, as these are prone to require secondary anti-reflux surgery in the long-term. Routine evaluation of GER including endoscopy and impedance measurement should be recommended especially for high-risk patients.
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12
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Zani A, Chung WK, Deprest J, Harting MT, Jancelewicz T, Kunisaki SM, Patel N, Antounians L, Puligandla PS, Keijzer R. Congenital diaphragmatic hernia. Nat Rev Dis Primers 2022; 8:37. [PMID: 35650272 DOI: 10.1038/s41572-022-00362-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a rare birth defect characterized by incomplete closure of the diaphragm and herniation of fetal abdominal organs into the chest that results in pulmonary hypoplasia, postnatal pulmonary hypertension owing to vascular remodelling and cardiac dysfunction. The high mortality and morbidity rates associated with CDH are directly related to the severity of cardiopulmonary pathophysiology. Although the aetiology remains unknown, CDH has a polygenic origin in approximately one-third of cases. CDH is typically diagnosed with antenatal ultrasonography, which also aids in risk stratification, alongside fetal MRI and echocardiography. At specialized centres, prenatal management includes fetal endoscopic tracheal occlusion, which is a surgical intervention aimed at promoting lung growth in utero. Postnatal management focuses on cardiopulmonary stabilization and, in severe cases, can involve extracorporeal life support. Clinical practice guidelines continue to evolve owing to the rapidly changing landscape of therapeutic options, which include pulmonary hypertension management, ventilation strategies and surgical approaches. Survivors often have long-term, multisystem morbidities, including pulmonary dysfunction, gastroesophageal reflux, musculoskeletal deformities and neurodevelopmental impairment. Emerging research focuses on small RNA species as biomarkers of severity and regenerative medicine approaches to improve fetal lung development.
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Affiliation(s)
- Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. .,Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Wendy K Chung
- Department of Paediatrics, Columbia University, New York, NY, USA
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child and Clinical Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium.,Institute for Women's Health, UCL, London, UK
| | - Matthew T Harting
- Department of Paediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA.,The Comprehensive Center for CDH Care, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Tim Jancelewicz
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shaun M Kunisaki
- Division of General Paediatric Surgery, Johns Hopkins Children's Center, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, UK
| | - Lina Antounians
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pramod S Puligandla
- Department of Paediatric Surgery, Harvey E. Beardmore Division of Paediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Paediatric Surgery, Paediatrics & Child Health, Physiology & Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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13
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Landolfo F, De Rose DU, Columbo C, Valfrè L, Massolo AC, Braguglia A, Capolupo I, Bagolan P, Dotta A, Morini F. Growth and morbidity in infants with Congenital Diaphragmatic Hernia according to initial lung volume: A pilot study. J Pediatr Surg 2022; 57:643-648. [PMID: 34281708 DOI: 10.1016/j.jpedsurg.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Background In congenital diaphragmatic hernia (CDH) survivors, failure to thrive is a well-known complication, ascribed to several factors. The impact of lung volume on growth of CDH survivors is poorly explored. Our aim was to evaluate if, in CDH survivors, lung volume (LV) after extubation correlates with growth at 12 and 24 months of life. Methods LV (measured as functional residual capacity-FRC) was evaluated by multibreath washout traces with an ultrasonic flowmeter and helium gas dilution technique, shortly after extubation. All CDH survivors are enrolled in a dedicated follow-up program. For the purpose of this study, we analyzed the correlation between FRC obtained shortly after extubation and anthropometric measurements at 12 and 24 months of age. We also compared growth between infants with normal lungs and those with hypoplasic lungs according to FRC values. A p < 0.05 was considered as statistically significant. Results We included in the study 22 CDH survivors who had FRC analyzed after extubation and auxological follow-up at 12 and 24 months of age. We found a significant correlation between FRC and weight Z-score at 12 months, weight Z-score at 24 months and height Z-score at 24 months. We also demonstrated that CDH infants with hypoplasic lungs had a significantly lower weight at 12 months and at 24 months and a significantly lower height at 24 months, when compared to infants with normal lungs. Conclusion We analyzed the predictive value of bedside measured lung volumes in a homogeneous cohort of CDH infants and demonstrated a significant correlation between FRC and growth at 12 and 24 months of age. An earlier identification of patients that will require an aggressive nutritional support (such as those with pulmonary hypoplasia) may help reducing the burden of failure to thrive.
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Affiliation(s)
- Francesca Landolfo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy.
| | - Claudia Columbo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Laura Valfrè
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Anna Claudia Massolo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Annabella Braguglia
- Neonatal Intermediate Care Unit and Follow-up, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Piazza S. Onofrio 4, Rome 00165, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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14
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Wild KT, Bartholomew D, Edwards TM, Froh E, Spatz DL, Huber M, Hedrick HL, Nawab US. Achieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge. J Pediatr Surg 2021; 56:2200-2206. [PMID: 33888352 DOI: 10.1016/j.jpedsurg.2021.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE To evaluate the enteral feeding requirements, including caloric provisions, of infants with CDH in relation to growth patterns. METHODS A retrospective observational study was conducted on infants with CDH between August 2012 and March 2017. Electronic medical records were reviewed to extract detailed infant feeding data and anthropometric measurements at monthly intervals until discharge. Statistical methods of analysis included generalized linear models, Pearson correlation coefficient, Analysis of variance (ANOVA), Kruskal-Wallis, Wilcoxon rank sum, and Fisher's Exact tests. RESULTS Among 149 infants with CDH, 45% (n = 67) met criteria for malnutrition at discharge. Maternal human milk (HM) was initiated in 95% of infants (n = 142) and continued in 79% of infants (n = 118) at discharge. Overall, 50% received fortification of feeds, including 60% (n = 89) of formula fed infants compared to only 21% (n = 31) of HM fed infants (p<0.001). Infants fed formula had lower weight-for-length z-scores at discharge compared to those fed HM. CONCLUSIONS Infants receiving HM demonstrated improved growth compared to formula fed infants. However, higher calorie feeding regimens need to be initiated earlier to improve growth velocity. Prompt recognition of malnutrition and growth failure with aggressive supplementation may improve the overall growth of infants with CDH and has the potential to improve long term neurodevelopmental outcomes.
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Affiliation(s)
- K Taylor Wild
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Division of Human Genetics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States.
| | - Dana Bartholomew
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Taryn M Edwards
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth Froh
- Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Diane L Spatz
- Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew Huber
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Holly L Hedrick
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Ursula S Nawab
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
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15
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Fleming H, Dempsey AG, Palmer C, Dempsey J, Friedman S, Galan HL, Gien J. Primary contributors to gastrostomy tube placement in infants with Congenital Diaphragmatic Hernia. J Pediatr Surg 2021; 56:1949-1956. [PMID: 33773801 DOI: 10.1016/j.jpedsurg.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify factors associated with gastrostomy tube (GT) placement in infants with congenital diaphragmatic hernia (CDH). METHODS Retrospective cohort study of 114 surviving infants with CDH at a single tertiary care neonatal intensive care unit from 2010-2019. Prenatal, perinatal and postnatal characteristics were compared between patients who were discharged home with and without a GT. Prenatal imaging was available for 50.9% of the cohort. Logistic regression was used to assess the association between GT placement and pertinent clinical factors. ROC curves were generated, and Youden's J statistic was used to determine optimal predictive cutoffs for continuous variables. Elastic net regularized regression was used to identify variables associated with GT placement in multivariable analysis. RESULTS GT was placed in 43.9% of surviving infants with CDH. Prenatal variables predictive of GT placement were percent predicted lung volume (PPLV) <21%, total lung volume (TLV) <30 ml, lung-head ratio (LHR) <1.2 or observed to expected LHR (O/E LHR) <55%. Infants who required a GT were diagnosed earlier prenatally (23.6 ± 3.4 vs. 26.4 ± 5.6 weeks). Patients whose stomach was above the diaphragm on prenatal ultrasound (up) had a higher odds of GT placement compared to those with stomachs below the diaphragm (down) position by a factor of 2.9 (95% CI: 1.25, 7.1); p = 0.0154. Postnatally, infants with GT had lower Apgar scores at 1 and 5 min, longer lengths of stay and higher proportion of flap closures. Infants with a type C or D defect and extracorporeal membrane oxygenation (ECMO) were associated with increased odds of needing a GT. Postnatal association included being NPO for >12 days, need for transpyloric (TP) feeds for >10 days, >14 days to transition to a 30 min bolus feed, presence of gastro-esophageal reflux (GER), chronic lung disease and pulmonary hypertension. In multivariable analysis, duration of NPO, time to TP feeds, transition to 30 min bolus feeds remained significantly associated with GT placement after adjusting for severity of pulmonary hypertension (PH), GER diagnosis and sildenafil treatment. CONCLUSION Identification of risk factors associated with need for long-term feeding access may improve timing of GT placement and prevent prolonged hospitalization related to feeding issues. LEVEL OF EVIDENCE RATING Level II (Retrospective Study).
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Affiliation(s)
- Hannah Fleming
- Department of Audiology, Speech and Learning, Children's Hospital Colorado. (Aurora, CO), Boulder, CO 80309, USA.
| | - Allison G Dempsey
- University of Colorado, Department of Psychiatry. (Aurora, CO), Boulder, CO 80309, USA
| | - Claire Palmer
- University of Colorado, Section of Neonatology (Aurora, CO), Boulder, CO 80309, USA
| | - Jack Dempsey
- University of Colorado, Section of Developmental Pediatrics (Aurora, CO), Boulder, CO 80309, USA
| | - Sandra Friedman
- University of Colorado, Section of Developmental Pediatrics (Aurora, CO), Boulder, CO 80309, USA
| | - Henry L Galan
- University of Colorado, Department of Obstetrics and Gynecology. (Aurora, CO), Boulder, CO 80309, USA
| | - Jason Gien
- University of Colorado, Section of Neonatology (Aurora, CO), Boulder, CO 80309, USA
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16
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Factors and Growth Trends Associated With the Need for Gastrostomy Tube in Neonates With Congenital Diaphragmatic Hernia. J Pediatr Gastroenterol Nutr 2021; 73:555-559. [PMID: 34117194 DOI: 10.1097/mpg.0000000000003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES A third of infants with congenital diaphragmatic hernia (CDH) require a gastrostomy tube (GT) for nutritional support. We compared CDH infants who are GT-dependent to those able to meet their nutritional needs orally, to identify factors associated with requiring a GT and evaluate their long-term growth. METHODS Patients with CDH repaired at a single institution between 2012 and 2020 were included. Charts were retrospectively reviewed for demographic, surgical, and post-operative details. Mann-Whitney test and Fischer exact test were performed to compare GT-dependent neonates (n = 38, experimental) with orally fed neonates (n = 63, control). Significance was set at <0.05. RESULTS Thirty-eight percent received a GT (median 67 days, interquartile range [IQR] 50-88). GT-dependent neonates were significantly more likely to have a lower lung-to-head ratio (median 1.2, IQR 0.9-1.4, vs 1.6, IQR 1.3-2.0, IQR P < 0.0001), undergone patch or flap repair (79% vs 33%, P < 0.0001), and been hospitalized longer (median 47, IQR 24-75 vs 28 days, P < 0.0001). Fourteen of 38 had their GT removed (median 26 months, IQR 14-36). GT-dependent neonates initiated oral feeds (calculated as time since extubation) later (median 21, IQR 8-26, vs 8 days, IQR 4-13, P = 0.006). Height-for-age z scores remained stable after GT removal, while weight-for-age z scores dropped initially and began improving a year later. CONCLUSIONS The need for a gastrostomy for nutritional support is associated with more severe CDH. Over a third of patients no longer needed a GT at a median of 26 months. Linear growth generally remains stable after removal. These results may help counsel parents regarding nutritional expectations.
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17
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McGann KC, Arca MJ, Pulhamus M, Livingston MH. Left congenital diaphragmatic hernia and gastroschisis in a term male infant. BMJ Case Rep 2021; 14:14/7/e239181. [PMID: 34301696 DOI: 10.1136/bcr-2020-239181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A term male infant was born to a healthy 24-year-old mother with antenatally diagnosed liver-up, left congenital diaphragmatic hernia (CDH) and gastroschisis. The infant was stabilised in the neonatal intensive care unit and then underwent primary repair of the CDH via left subcostal incision and silo placement for the gastroschisis. Serial silo reductions were started postoperatively and umbilical flap closure for the gastroschisis was performed on day of life 6. The patient was weaned from respiratory support, started on enteral feeds, and discharged home at 1 month of age. He was weaned from supplemental nasogastric feeds by 6 weeks of age and is currently well and thriving at 11 months of age.
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Affiliation(s)
- Kevin C McGann
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Marjorie J Arca
- Division of Pediatric Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Marsha Pulhamus
- Division of Pediatric Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael H Livingston
- Division of Pediatric Surgery, University of Rochester Medical Center, Rochester, New York, USA
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18
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Weller K, Peters NCJ, van Rosmalen J, Cochius-Den Otter SCM, DeKoninck PLJ, Wijnen RMH, Cohen-Overbeek TE, Eggink AJ. Prenatal stomach position and volume in relation to postnatal outcomes in left-sided congenital diaphragmatic hernia. Prenat Diagn 2021; 42:338-347. [PMID: 34292626 PMCID: PMC9290604 DOI: 10.1002/pd.6019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 12/04/2022]
Abstract
Objective To examine the association between prenatal stomach position (SP) grade and stomach volume (SV) and the need for pulmonary hypertension (PH) treatment after birth in prenatally diagnosed left‐sided congenital diaphragmatic hernia (CDH), live born >34 weeks. Methods In retrospect, SP grade and SV were determined in fetuses with isolated left‐sided CDH from 19 weeks gestational age (GA) onwards at three different time periods (≤24 weeks' GA: US1, 24–30 weeks' GA: US2; ≥30 weeks' GA: US3). Primary outcome was need for treatment of PH after birth. Secondary analyses included the predictive value of SP and SV for other respiratory outcomes and postnatal defect size. Results A total of 101 fetuses were included. SP grade was significantly associated with need for treatment of PH (US1, US2, and US3: p < 0.02). Also, prenatal SP grade was positively associated with defect size and development of chronic lung disease (CLD) in survivors. No association was found between SV and respiratory morbidities or postnatal defect size. Conclusion SP grade in left‐sided CDH fetuses is associated with an increased need for PH treatment, a larger postnatal defect size and CLD in survivors. We consider SP determination a valuable contribution to the prenatal assessment of left‐sided CDH.
What is already known about this topic?
Prenatal stomach position (SP) grade has been proposed as a predictive ultrasound parameter for postnatal survival, patch repair, need for extracorporeal membrane oxygenation and need for prolonged respiratory support in left‐sided congenital diaphragmatic hernia (CDH).
What does this study add?
In children with left‐sided CDH, prenatal SP grade is associated with an increase in need for treatment of pulmonary hypertension and development of chronic lung disease, with the greatest increase in SP Grade 2 and 4. A higher prenatal SP grade is associated with a larger postnatal defect size. In the majority of cases SP grade does not vary throughout gestation.
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Affiliation(s)
- Katinka Weller
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nina C J Peters
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzan C M Cochius-Den Otter
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Philip L J DeKoninck
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rene M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alex J Eggink
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital University Medical Center Rotterdam, Rotterdam, The Netherlands
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19
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Al Baroudi S, Collaco JM, Nies MK, Rice JL, Jelin EB. Health-related quality of life of caregivers of children with congenital diaphragmatic hernia. Pediatr Pulmonol 2021; 56:1659-1665. [PMID: 33634600 DOI: 10.1002/ppul.25339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) is a congenital defect associated with significant mortality and morbidity. We sought to assess the health-related quality of life (HRQoL) for caregivers of infants/children with CDH and determine risk factors for poorer HRQoL. METHODS Families were recruited from a CDH-specific outpatient clinic and HRQoL was assessed by a validated HRQoL instrument (PedsQLTM Family Impact Module) at several time points. Mixed models were used to identify demographic and clinical factors associated with worse HRQoL for caregivers. RESULTS A total of 29 subjects were recruited at a mean age of 2.4 ± 2.3 years. In terms of defect size, 6.9% had a Type A, 37.9% a Type B, 31.0% a Type C, and 24.1% a Type D. The mean HRQoL score at the first encounter was 67.6 ± 18.3; scores are reported from 0 to 100 with higher scores representing the higher reported quality of life. Lower median household incomes (p = .021) and use of extracorporeal membrane oxygenation (p = .013) were associated with poorer HRQoL scores. The presence of respiratory symptoms decreased HRQoL for caregivers, including daytime symptoms (p < .001) and nighttime symptoms (p < .001). While emergency department visits were not associated with a decrease in HRQoL, hospital admissions (p = .002), and reoperations for CDH (p < .001) were. CONCLUSION Our study found a reduced quality of life associated with socioeconomic factors and severity of ongoing disease. Further study is needed to confirm these findings and identify strategies for aiding families cope with the chronicity of this congenital disease.
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Affiliation(s)
- Sahar Al Baroudi
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph M Collaco
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Melanie K Nies
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jessica L Rice
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Eric B Jelin
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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20
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Van der Veeken L, Vergote S, Kunpalin Y, Kristensen K, Deprest J, Bruschettini M. Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta-analysis. Prenat Diagn 2021; 42:318-329. [PMID: 33533064 DOI: 10.1002/pd.5916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) reportedly has neurologic consequences in childhood however little is known about the impact in isolated CDH. AIMS Herein we aimed to describe the risk of neurodevelopmental complications in children born with isolated CDH. MATERIALS & METHODS We systematically reviewed literature for reports on the neurological outcome of infants born with isolated CDH. The primary outcome was neurodevelopmental delay. Secondary outcomes included, motor skills, intelligence, vision, hearing, language and behavior abnormalities. RESULTS Thirteen out of 87 (15%) studies reported on isolated CDH, including 2624 out of 24,146 children. Neurodevelopmental delay was investigated in four studies and found to be present in 16% (3-34%) of children. This was mainly attributed to motor problems in 13% (2-30%), whereas cognitive dysfunction only in 5% (0-20%) and hearing in 3% (1-7%). One study assessed the effect of fetal surgery. When both isolated and non-isolated children were included, these numbers were higher. DISCUSSION This systematic review demonstrates that only a minority of studies focused on isolated CDH, with neurodevelopmental delay present in 16% of children born with CDH. CONCLUSION To accurately counsel patients, more research should focus on isolated CDH cases and examine children that underwent fetal surgery.
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Affiliation(s)
- Lennart Van der Veeken
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Simen Vergote
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Yada Kunpalin
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
| | - Karl Kristensen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
| | - Matteo Bruschettini
- Department of Pediatrics, Lund University, Skåne University Hospital, Lund, Sweden.,Cochrane Sweden, Skåne University Hospital, Lund, Sweden
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21
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Bathgate JR, Rigassio Radler D, Zelig R, Lagoski M, Murthy K. Nutrition Interventions Associated With Favorable Growth in Infants With Congenital Diaphragmatic Hernia. Nutr Clin Pract 2020; 36:406-413. [PMID: 32621640 DOI: 10.1002/ncp.10547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Nutrition complications are common in survivors of congenital diaphragmatic hernia (CDH). Infants diagnosed with CDH may demonstrate poor growth despite receiving enteral tube feedings and gastroesophageal reflux treatment. This literature review was conducted to determine nutrition interventions resulting in favorable growth, which may improve outcomes in these infants. Results indicate that early nutrition support, including supplemental parenteral nutrition with provisions of ≥125 kcal/kg/d and ≥2.3 g/kg/d protein (which are higher than dietary reference intakes for infants), may have a positive impact on growth, potentially impacting neurological development.
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Affiliation(s)
- Jennifer R Bathgate
- School of Health Professions, Department of Clinical and Preventive, Lurie Children's Hospital, Nutrition Sciences, Rutgers University, Chicago, Illinois, USA
| | - Diane Rigassio Radler
- School of Health Professions, Department of Clinical and Preventive, Nutrition Sciences, Rutgers University, Chicago, Illinois, USA
| | - Rena Zelig
- School of Health Professions, Department of Clinical and Preventive, Nutrition Sciences, Rutgers University, Chicago, Illinois, USA
| | - Megan Lagoski
- Feinberg School of Medicine, Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Karna Murthy
- Feinberg School of Medicine, Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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22
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Abstract
Survivorship of patients with congenital diaphragmatic hernia (CDH) has created a unique cohort of children, adolescents and adults with complex medical and surgical needs. Morbidities specific to this disease benefit from multi-specialty care, and the long term follow up of these patients offers a tremendous opportunity for research and collaboration. Herein we aim to offer an overview of the challenges that modern CDH survivors face, and include a risk-stratified algorithm as a general guideline for a multi-specialty follow up program.
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Affiliation(s)
- Laura E Hollinger
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 613/CSB 417, Charleston SC 29425, USA.
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23
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Requirement and Duration of Tube Feed Supplementation among Congenital Diaphragmatic Hernia Patients. J Pediatr Surg 2019; 54:895-898. [PMID: 30773392 DOI: 10.1016/j.jpedsurg.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Oral feeds pose a challenge for congenital diaphragmatic hernia (CDH) infants. Tube feed (TF) supplementation may be required to support the achievement of normal growth. The aim of this study was to determine the duration and factors associated with TF use in CDH infants at our institution. METHODS A single centre retrospective chart review was performed for CDH-born infants who underwent repair between 2000 to 2013 (REB #1000053124). Patient demographics, perinatal management, and feeding status of infants with at least 1-year follow-up were reviewed. RESULTS Of 160 CDH infants, 32 (20%) were discharged on partial or complete TF, and an additional 5 (3.1%) patients started TF post discharge. CDH infants with TF were more likely to have initial arterial blood pH < 7.25, patch repair, ECMO support, and prolonged ICU stay (p < 0.05). Time to TF discontinuation did not differ significantly between those partially or fully TF at discharge. Twelve patients (33.3%) remained TF at their last known follow-up. CONCLUSION High risk CDH patients are likely to require TF to support their nutritional intake. Parents and caregivers need to be informed and properly supported. Long-term monitoring of CDH patient oral intake, growth, and development will be required. LEVEL OF EVIDENCE/TYPE OF STUDY Level III Retrospective Study.
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24
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Fritz KA, Khmour AY, Kitzerow K, Sato TT, Basir MA. Health-related quality of life, educational and family outcomes in survivors of congenital diaphragmatic hernia. Pediatr Surg Int 2019; 35:315-320. [PMID: 30417228 DOI: 10.1007/s00383-018-4414-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Congenital diaphragmatic hernia (CDH) survivors experience increased risk of medical and neurodevelopmental challenges. This study describes the health-related quality of life (HRQOL), special education utilization and the family impact among neonatal CDH survivors. METHODS A single-center prospective cohort of CDH survivors born between 1995 and 2006 was followed. Parents completed the PedsQL HRQOL index and a Family Impact survey to assess the need for medical equipment, home health services, and special education and quantify the burden placed on the family by their child's medical needs. RESULTS Parents of 32 survivors participated at a mean survivor age of 8 ± 4 years. Many survivors utilized medical equipment (62%), home health services (18%) and special education (28%). CDH survivor HRQOL (79 ± 17) did not differ significantly from that of healthy children (83 ± 15, p = 0.12). HRQOL was diminished among survivors who required special education (67 ± 8 vs 82 ± 3; p = 0.04) and those reporting increased Family Impact score (p = 0.001). CONCLUSION Many CDH survivors continue to require home medical equipment and home health services at school age. Most survivors have normal parent-reported HRQOL; however, the need for special education and higher family impact of neonatal CDH correlates with decreased HRQOL.
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Affiliation(s)
- Katie A Fritz
- Suite CCC-410, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Ayman Y Khmour
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Krista Kitzerow
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas T Sato
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mir A Basir
- Suite CCC-410, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
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25
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Resting energy expenditure in infants with congenital diaphragmatic hernia without respiratory support at time of neonatal hospital discharge. J Pediatr Surg 2018; 53:2100-2104. [PMID: 30244939 DOI: 10.1016/j.jpedsurg.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 06/18/2018] [Accepted: 08/16/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Infants with congenital diaphragmatic hernia (CDH) are at risk for growth failure because of inadequate caloric intake and high catabolic stress. There is limited data on resting energy expenditure (REE) in infants with CDH. AIMS To assess REE via indirect calorimetry (IC) in term infants with CDH who are no longer on respiratory support and nearing hospital discharge with advancing post-conceptional age and to assess measured-to-predicted REE using predictive equations. METHODS A prospective cohort study of term infants with CDH who were no longer on respiratory support and nearing hospital discharge was conducted to assess REE via IC and caloric intake. Baseline characteristics and hospital course data were collected. Three day average caloric intake around time of IC testing was calculated. Change in REE with advancing post-conceptional age and advancing post-natal age was assessed. The average measured-to-predicted REE was calculated for the cohort using predictive equations [22]. RESULTS Eighteen infants with CDH underwent IC. REE in infants with CDH increased with advancing postconceptional age (r2 = 0.3, p < 0.02). The mean REE for the entire group was 53.2 +/- 10.9 kcal/kg/day while the mean caloric intake was 101.2 +/- 17.4 kcal/kg/day. The mean measured-to-predicted ratio for the cohort was in the normal metabolic range (1.10 +/- 0.17) with 50% of infants considered hypermetabolic and 11% of infants considered hypo-metabolic. CONCLUSIONS Infant survivors of CDH repair who are without respiratory support at time of neonatal hospital discharge have REE, as measured by indirect calorimetry, that increases with advancing post-conceptional age and that is within the normal metabolic range when compared to predictive equations. LEVEL OF EVIDENCE III.
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26
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Defining outcomes following congenital diaphragmatic hernia using standardised clinical assessment and management plan (SCAMP) methodology within the CDH EURO consortium. Pediatr Res 2018; 84:181-189. [PMID: 29915407 DOI: 10.1038/s41390-018-0063-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 01/29/2023]
Abstract
Treatment modalities for neonates born with congenital diaphragmatic hernia (CDH) have greatly improved in recent times with a concomitant increase in survival. In 2008, CDH EURO consortium, a collaboration of a large volume of CDH centers in Western Europe, was established with a goal to standardize management and facilitate multicenter research. However, limited knowledge on long-term outcomes restricts the identification of optimal care pathways for CDH survivors in adolescence and adulthood. This review aimed to evaluate the current practice of long-term follow-up within the CDH EURO consortium centers, and to review the literature on long-term outcomes published from 2000 onward. Apart from having disease-specific morbidities, children with CDH are at risk for impaired neurodevelopmental problems and failure of educational attainments which may affect participation in society and the quality of life in later years. Thus, there is every reason to offer them long-term multidisciplinary follow-up programs. We discuss a proposed collaborative project using standardized clinical assessment and management plan (SCAMP) methodology to obtain uniform and standardized follow-up of CDH patients at an international level.
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27
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Antiel RM, Lin N, Licht DJ, Hoffman C, Waqar L, Xiao R, Monos S, D'Agostino JA, Bernbaum J, Herkert LM, Rintoul NE, Peranteau WH, Flake AW, Adzick NS, Hedrick HL. Growth trajectory and neurodevelopmental outcome in infants with congenital diaphragmatic hernia. J Pediatr Surg 2017; 52:1944-1948. [PMID: 29079316 DOI: 10.1016/j.jpedsurg.2017.08.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of impaired growth on short-term neurodevelopmental (ND) outcomes in CDH survivors. METHODS Between 9/2005-12/2014, 84 of 215 (39%) CDH survivors underwent ND assessment at 12months of age using the BSID-III. RESULTS Mean cognitive, language, and motor scores were 92.6±13.5, 87.1±11.6, and 87.0±14.4, respectively (normal 100±15). 51% of patients scored 1 SD below the population mean in at least one domain, and 13% scored 2 SD below the population mean. Group-based trajectory analysis identified two trajectory groups ('high' and 'low') for weight, length, and head circumference (HC) z-scores. (Fig. 1) 74% of the subjects were assigned to the 'high' trajectory group for weight, 77% to the 'high' height group, and 87% to the 'high' HC group, respectively. In multivariate analysis, longer NICU stay (p<0.01) was associated with lower cognitive scores. Motor scores were 11 points higher in the 'high' HC group compared to the 'low' HC group (p=0.05). Motor scores were lower in patients with longer NICU length of stay (p<0.001). CONCLUSIONS At 1 year, half of CDH survivors had a mild delay in at least one developmental domain. Low HC trajectory was associated with worse neurodevelopmental outcomes. TYPE OF STUDY Prognosis Study/Retrospective Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ryan M Antiel
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nan Lin
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Licht
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Casey Hoffman
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lindsay Waqar
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rui Xiao
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stylianos Monos
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jo Ann D'Agostino
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy Bernbaum
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa M Herkert
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie E Rintoul
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William H Peranteau
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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28
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Morini F, Valfrè L, Bagolan P. Long-term morbidity of congenital diaphragmatic hernia: A plea for standardization. Semin Pediatr Surg 2017; 26:301-310. [PMID: 29110826 DOI: 10.1053/j.sempedsurg.2017.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Congenital diaphragmatic hernia (CDH) survivors present long-term morbidities in several systems, including the neurodevelopmental, gastrointestinal, pulmonary, and musculoskeletal ones, and CDH long-term sequelae are increasingly being recognized. Due to high co-morbidity, health related quality of life in a significant proportion of CDH patients might be compromised. As a consequence of consciousness on the long-term sequelae of CDH survivors, and their consequences for life, several follow-up programs were brought to life worldwide. In this review, we will summarize the long-term sequelae of CDH survivors, the impact of new treatments, and analyze the consistency of follow-up programs.
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Affiliation(s)
- Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Valfrè
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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29
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IJsselstijn H, Gischler SJ, Wijnen RMH, Tibboel D. Assessment and significance of long-term outcomes in pediatric surgery. Semin Pediatr Surg 2017; 26:281-285. [PMID: 29110823 DOI: 10.1053/j.sempedsurg.2017.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment modalities for newborns with anatomical congenital anomalies have greatly improved over the past decades, with a concomitant increase in survival. This review will briefly discuss specific long-term outcomes to illustrate, which domains deserve to be considered in long-term follow-up of patients with anatomical congenital anomalies. Apart from having disease-specific morbidities these children are at risk for impaired neurodevelopmental problems and school failure, which may affect participation in society in later life. There is every reason to offer them long-term multidisciplinary follow-up programs. We further provide an overview of the methodology of long-term follow-up, its significance and discuss ways to improve care for newborns with anatomical congenital anomalies from childhood into adulthood. Future initiatives should focus on transition of care, risk stratification, and multicenter collaboration.
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Affiliation(s)
- Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands.
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
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30
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Closer Look at the Nutritional Outcomes of Patients After Primary Repair of Congenital Diaphragmatic Hernia. J Pediatr Gastroenterol Nutr 2017; 65:237-241. [PMID: 28489671 DOI: 10.1097/mpg.0000000000001627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES We hypothesize that the patients after primary repair of congenital diaphragmatic hernia (CDH) can have poor nutritional outcomes and plan to identify risk factors to further stratify these patients. METHODS Retrospective cohort of patients who had primary repair of CDH between 2000 and 2014 and had follow-up at our institution. Z scores (weight for age and weight for length) were calculated using the World Health Organization and Centers for Disease Control and Prevention growth standards. RESULTS For the 67 patients in the cohort, the median age at the time of repair was 3 days (interquartile range 2-5) and at the time of discharge was 20.5 days (interquartile range 16-30). Fifteen percent of the patients required supplemental tube feeding for inadequate oral intake and 69% required fortified feedings for inadequate growth at discharge (4 patients subsequently needed gastrostomy tube placement). The median z scores at discharge were -1.0 (-2.1 to -0.3) and -1.2 (-2.3 to -0.5) in weight for age and weight for length, respectively. The risk factors for low z scores included open repair and longer periods of postoperative intubation or hospitalization. The z scores were similar at 6 months of age compared to discharge, but then statistically improved at 12 months of age. CONCLUSIONS Patients with primary repair of CDH are at risk for poor nutritional outcomes at the time of hospital discharge and require follow-up to ensure adequate growth. Patients at highest risk are those who had an open repair and had prolonged intubation or hospitalization.
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Abstract
Increased survival of patients with congenital diaphragmatic hernia has created a unique cohort of children, adolescent, and adult survivors with complex medical and surgical needs. Disease-specific morbidities offer the opportunity for multiple disciplines to unite together to provide long-term comprehensive follow-up, as well as an opportunity for research regarding late outcomes. These children can exhibit impaired pulmonary function, altered neurodevelopmental outcomes, nutritional insufficiency, musculoskeletal changes, and specialized surgical needs that benefit from regular monitoring and intervention, particularly in patients with increased disease severity. Below we aim to characterize the specific challenges that these survivors face as well as present an algorithm for a multidisciplinary long-term follow-up program.
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Affiliation(s)
- Laura E Hollinger
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, Texas 77030
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, Texas 77030
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, Texas 77030.
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32
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Haliburton B, Mouzaki M, Chiang M, Scaini V, Marcon M, Duan W, Wilson D, Chiu PPL, Moraes TJ. Pulmonary function and nutritional morbidity in children and adolescents with congenital diaphragmatic hernia. J Pediatr Surg 2017; 52:252-256. [PMID: 27912974 DOI: 10.1016/j.jpedsurg.2016.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Malnutrition is common among congenital diaphragmatic hernia (CDH) survivors and may result from elevated respiratory effort. We evaluated body mass index (BMI), measured resting energy expenditure (mREE) and pulmonary function test (PFT) results in children and adolescents with CDH to determine if there is a correlation. METHODS With ethics approval (REB# 1000035323), anthropometrics, indirect calorimetry (IC) results and PFTs were collected from patients 5-17years of age during CDH clinic visits between 2000 and 2016. Malnutrition was defined as BMI z-scores <-2.0; mREE (as percent predicted REE) was measured using IC; z-scores for forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were normal if <-1.64. STATISTICS GraphPad Prism 6, San Diego, CA. RESULTS & DISCUSSION Of 118 patients who attended clinic, 33 had reproducible PFTs, anthropometrics and IC results. Mean BMI z-score was -0.89±1.47 and 24% of patients were malnourished; mean FVC z-score (-1.32±1.39) was within normal range, whereas mean z-scores for FEV1 (-2.21±1.68) and FEV1/FVC ratio (-1.78±0.73) were below normal. A correlation was noted between BMI and PFTs (FEV1 r=0.70, P<0.0001; FVC r=0.74 P<0.0001). Mean mREE was 112%±12% of expected and 67% of patients were hypermetabolic (mREE<110% predicted). IC results did not correlate with z-scores for either FEV1 (r=0.10, P=0.57); or FVC (r=0.28, P=0.12). CONCLUSIONS These preliminary results suggest that a correlation is present between BMI and lung function in CDH children and adolescents, whereas lung function does not seem to correlate with mREE. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Beth Haliburton
- Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Marialena Mouzaki
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Monping Chiang
- Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Vikki Scaini
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Margaret Marcon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Wenming Duan
- Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - David Wilson
- Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Priscilla P L Chiu
- Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Theo J Moraes
- Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
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Shieh HF, Wilson JM, Sheils CA, Smithers CJ, Kharasch VS, Becker RE, Studley M, Morash D, Buchmiller TL. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors? J Pediatr Surg 2017; 52:22-25. [PMID: 27836357 DOI: 10.1016/j.jpedsurg.2016.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/20/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE In high-risk congenital diaphragmatic hernia (CDH), significant barotrauma or death can occur before extracorporeal membrane oxygenation (ECMO) can be initiated. We previously examined ex utero intrapartum treatment (EXIT)-to-ECMO in our most severe CDH patients, but demonstrated no survival advantage. We now report morbidity outcomes in survivors of this high-risk cohort to determine whether EXIT-to-ECMO conferred any benefit. METHODS All CDH survivors with <15% predicted lung volume (PPLV) from September 1999 to December 2010 were included. We recorded prenatal imaging, defect size, and pulmonary, nutritional, cardiac, and neurodevelopmental outcomes. RESULTS Seventeen survivors (8 EXIT-to-ECMO, 9 non-EXIT) had an average PPLV of 11.7%. Eight of 9 non-EXIT received ECMO within 2days. There were no significant defect size differences between groups, mostly left-sided (13/17) and type D (12/17). Average follow-up was 6.7years (0-13years). There were no statistically significant differences in outcomes, including supplemental oxygen, diuretics, gastrostomy, weight-for-age Z scores, fundoplication, pulmonary hypertension, stroke or intracranial hemorrhage rate, CDH recurrence, and reoperation. No survivor in our cohort was neurologically devastated. All had mild motor and/or speech delay, which improved in most. CONCLUSIONS In this pilot series of severe CDH survivors, EXIT-to-ECMO confers neither significant survival nor long-term morbidity benefit. LEVEL OF EVIDENCE Level III treatment study.
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Affiliation(s)
- Hester F Shieh
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jay M Wilson
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Catherine A Sheils
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - C Jason Smithers
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Virginia S Kharasch
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ronald E Becker
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mollie Studley
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Donna Morash
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA.
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Van Ginderdeuren E, Allegaert K, Decaluwe H, Deprest J, Debeer A, Proesmans M. Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention. Neonatology 2017; 112:365-371. [PMID: 28866670 DOI: 10.1159/000479145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is an abnormal development of the diaphragm leading to high neonatal mortality and morbidity. Beyond the neonatal period, prospective data on overall long-term outcome in CDH survivors is scarce. In particular, for those treated with fetoscopic endoluminal tracheal occlusion (FETO), a promising new technique to increase survival chances for severe cases, the outcomes are even less documented. AIM To prospectively document the clinical outcome of CDH at 1 year including FETO-treated infants in relation to ante- and postnatal variables. METHODS A single-centre prospective clinical follow-up at 1 year of age included a standardised respiratory questionnaire. RESULTS Thirty-four CDH survivors were included, 10 of which were FETO-treated infants. At 1 year, the median weight z score was -1.50 (interquartile range [IQR]: -2.45 to -0.88) and 10/34 were "failure to thrive" (FTT) cases. Gastro-intestinal (GI) problems at 1 year were mainly related to gastro-oesophageal reflux (16/34) with a high need for tube feeding in the first year (9/34). Tachypnoea was present in 10/29 (34%) and 8/34 (24%) were on chronic inhaled medication. The median total respiratory symptom score was 20 (IQR: 13-32) and correlated with the number of neonatal ventilation days (p = 0.048). Hospital re-admission occurred in 19/34 infants (56%), and was for respiratory problems in almost half of them (8/19). CONCLUSION In this CDH cohort, morbidity at 1 year was determined more by GI problems and FTT than respiratory morbidity. The respiratory questionnaire may, however, have underestimated the respiratory morbidity since respondents had a 1-in-4 chance to have persistent tachypnoea and be on chronic inhalation therapy.
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Affiliation(s)
- Eva Van Ginderdeuren
- Paediatrics (Paediatric Pulmonology),, University Hospitals Leuven, Leuven, Belgium
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Rudra S, Adibe OO, Malcolm WF, Smith PB, Cotten CM, Greenberg RG. Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes. Early Hum Dev 2016; 103:97-100. [PMID: 27559682 PMCID: PMC5154903 DOI: 10.1016/j.earlhumdev.2016.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastrostomy tube (G-tube) placement is a common intervention for newborns with severe feeding difficulties. Infants with congenital diaphragmatic hernia (CDH) are at high risk for feeding problems. Prevalence of G-tube placement and consequent nutritional outcomes of infants with CDH and G-tubes has not been described. AIMS Determine factors associated with G-tube placement and growth in infants with congenital diaphragmatic hernia. STUDY DESIGN Retrospective cohort study of infants with CDH to evaluate the association of G-tube placement with risk factors using logistic regression. We also assessed the association between growth velocity and G-tube placement and other risk factors using linear regression. SUBJECTS The subjects of the study were infants with CDH treated at Duke University Medical Center from 1997 to 2013. OUTCOME MEASURES Weight gain in infants with CDH that had G-tube placement compared to those infants with CDH that did not. RESULT Of the 123 infants with CDH, 85 (69%) survived and G-tubes were placed in 25/85 (29%) survivors. On adjusted analysis, extracorporeal membrane oxygenation (OR=11.26 [95% CI: 1.92-65.89]; P=0.01) and proton pump inhibitor use (OR=17.29 [3.98-75.14], P≤0.001) were associated with G-tube placement. Infants without G-tubes had a growth velocity of 6.5g/day (95% CI: 2.5-10.4) more than infants with G-tubes. CONCLUSION Survivors with more complex inpatient courses were more likely to receive G-tubes. Further investigation is needed to identify optimal feeding practices for infants with CDH.
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Affiliation(s)
- Sharmistha Rudra
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Obinna O Adibe
- Department of Surgery, Duke University Medical Center, Durham, NC, United States.
| | - William F Malcolm
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
| | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States; Duke Clinical Research Institute, Durham, NC, United States.
| | - C Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States; Duke Clinical Research Institute, Durham, NC, United States.
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King SK, Alfaraj M, Gaiteiro R, O'Brien K, Moraes T, Humpl T, Marcon M, Chiang M, Reyes J, Haliburton B, Ryan G, Cox P, Chiu PPL. Congenital diaphragmatic hernia: Observed/expected lung-to-head ratio as a predictor of long-term morbidity. J Pediatr Surg 2016; 51:699-702. [PMID: 26932249 DOI: 10.1016/j.jpedsurg.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 02/07/2016] [Indexed: 02/06/2023]
Abstract
AIM The aim of this study was to investigate the association of observed/expected (O/E) lung-to-head ratio (LHR) with long-term morbidity for isolated fetal congenital diaphragmatic hernia (CDH) patients in a single institution. METHODS We performed a retrospective study of prenatally diagnosed CDH from 18 to 38weeks of gestation (01/2002-04/2010). Two cohorts of O/E LHR were defined (22.6-45%, 45.1-78.3%) based upon previous studies. Survivors with at least 1-year follow-up of prospectively collected long-term morbidity assessments were included. RESULTS O/E LHR was available in 43 survivors (median 40%, range 22.8-78.3%). Follow-up data were available in 41 survivors (M:F=24:17, left CDH=39/41). Median follow-up was 6.5years (1-11years). Height/weight trajectories were similar between the two cohorts, with the majority below the 50th centile. There were no differences between the two cohorts by age 3years for Bayley scales (developmental domains) and/or REEL-3 (language development). In addition, V/Q scans in the two cohorts demonstrated similar degrees of mismatch (mean delta V/Q=35.4 versus 31.3). CONCLUSIONS In fetuses with isolated CDH, a reduction in O/E LHR does not predict a worse outcome in long-term follow-up. There is no association between a lower O/E LHR and a reduction in REEL-3 or Bayley score nor V/Q mismatch.
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Affiliation(s)
- Sebastian K King
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Malikah Alfaraj
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rose Gaiteiro
- Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karel O'Brien
- Division of Neonatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Theo Moraes
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tilman Humpl
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margaret Marcon
- Division of Gastroenterology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monping Chiang
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janette Reyes
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beth Haliburton
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Cox
- Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Nutritional Intake, Energy Expenditure, and Growth of Infants Following Congenital Diaphragmatic Hernia Repair. J Pediatr Gastroenterol Nutr 2016; 62:474-8. [PMID: 26465794 DOI: 10.1097/mpg.0000000000001000] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/OBJECTIVES The pathophysiology of failure to thrive in congenital diaphragmatic hernia (CDH) has not been fully elucidated, and the nutritional care of these infants is hindered by paucity of data on the optimal calorie requirements for growth. The primary objective of this study was to investigate the energy intake required for infants with CDH to grow optimally at the time of first hospital discharge. The secondary objectives were to assess their measured resting energy expenditure in infancy, and their long-term growth outcomes. METHODS Nutritional intake, anthropometrics, indirect calorimetry results, and respiratory status of infants with CDH from 2011 to 2014 were collected retrospectively. Data on confounders (gastroesophageal reflux disease and feeding intolerance, respiratory rate and pulmonary hypertension) were also collected. Analyses were performed using Stata (College Station, TX). RESULTS Of the 72 infants diagnosed with CDH during that period of time, 43 met the inclusion criteria. A caloric intake of 125.0 ± 20 kcal · kg · day was required to meet discharge weight gain criteria (25-35 g · kg · day). In a subset of 17 patients, measured resting energy expenditure was higher than predicted resting energy expenditure (58.0 ± 18 vs 46.6 ± 3 kcal · kg · day, P < 0.05), and 59% of infants were hypermetabolic (measured resting energy expenditure >110% of predicted resting energy expenditure) in early infancy. Failure to thrive prevalence at discharge was 16.2% compared to 3.6% and 4.2% at 12- and 24-months of age, respectively (P = 0.03; P = 0.005, respectively). CONCLUSIONS Optimal weight gain can be achieved with higher than predicted calorie provision. Most infants with CDH are hypermetabolic. Despite this, failure to thrive prevalence can improve during the first year of life.
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