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Kraemer US, Kamphuis LS, Ciet P, Visser L, Tibboel D, Bartelds B, Cochius-den Otter SCM, de Blaauw I, van Rosmalen J, Gischler SJ, Schnater JM, IJsselstijn H. Cardiopulmonary Morbidity in Adults Born With Congenital Diaphragmatic Hernia. Pediatrics 2023; 152:e2023062341. [PMID: 37750210 DOI: 10.1542/peds.2023-062341] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Studies concerning cardiopulmonary outcomes of adults born with congenital diaphragmatic hernia (CDH) are sparse. Moreover, they don't include participants who have been treated with extracorporeal membrane oxygenation (ECMO) during the neonatal period. This study evaluated the cardiopulmonary morbidities in young adults born with CDH. METHODS We assessed 68 participants between the ages of 18 and 30 years. The assessment included auxology assessment, lung function tests, pulmonary imaging, cardiopulmonary exercise testing, and echocardiography. RESULTS Lung function parameters in the overall group were significantly worse than normal values. Mean (SD) scores postbronchodilator forced expiratory volume in 1 second were -2.91 (1.38) in the ECMO-treated and -1.20 (1.53) in the non-ECMO-treated participants. Chest computed tomography scans showed mild to moderate abnormal lung structure in all ECMO-treated participants, and to a lesser extent in non-ECMO treated participants. A recurrent diaphragmatic defect was observed in 77% of the ECMO-treated group and in 43% of the non-ECMO-treated group. Except for 2 cases with acute symptoms, no clinical problems were noted in cases of recurrence. Cardiopulmonary exercise testing revealed mean (SD) percentage predicted peak oxygen consumption per kilogram of 73 (14)% and 88 (16)% in ECMO-treated and non-ECMO-treated participants, respectively. The mean (SD) workload was normal in the non-ECMO-treated group (111 [25]% predicted); in the ECMO-treated group, it was 89 (23)%. Cardiac evaluation at rest revealed no signs of pulmonary hypertension. CONCLUSIONS In young adults who survived treatment of CDH, significant pulmonary morbidity, reduced exercise capacity, and frequent hernia recurrence should be anticipated. Lifelong follow-up care, with the emphasis on prevention of further decline, is to be recommended.
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Affiliation(s)
- Ulrike S Kraemer
- Department of Pediatric Surgery
- Division of Pediatric Intensive Care, Department of Pediatric & Neonatal Intensive Care
| | | | | | | | | | - Beatrijs Bartelds
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
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2
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Hoskote A, Hunfeld M, O'Callaghan M, IJsselstijn H. Neonatal ECMO survivors: The late emergence of hidden morbidities - An unmet need for long-term follow-up. Semin Fetal Neonatal Med 2022; 27:101409. [PMID: 36456434 DOI: 10.1016/j.siny.2022.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Aparna Hoskote
- Cardiac Intensive Care Unit, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - Maayke Hunfeld
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Maura O'Callaghan
- Cardiac Intensive Care Unit, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Hanneke IJsselstijn
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
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Moinichen UI, Mikkelsen A, Faugli A, Morkrid L, IJsstelstijn H, Emblem R. Impaired motor performance in adolescents with esophageal atresia. J Pediatr Surg 2021; 56:1926-1931. [PMID: 33298324 DOI: 10.1016/j.jpedsurg.2020.11.026] [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: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS The study prospectively assessed motor development from infancy to adolescence in patients with esophageal atresia (EA). METHODS At one year of age motor performance was evaluated with the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development, Second Edition (BSID-II), and as adolescents reevaluated with Motor Assessment Battery for Children, Second Edition (MABC-2). Associations to clinical factors were assessed. RESULTS 23 EA patients were followed from infancy to adolescence. The median total PDI score in infancy was 102 (56-118) and the corresponding mean z-score was -0.006 (SD 0.995) and not significantly different from the reference values (p = 0.48). The median total MABC-2 score in adolescence was 75 (32-93) and the corresponding mean z-score -0.43 (SD 0.998) which is significantly below normal (p = 0.03). Children with impaired motor function in adolescence underwent significantly more rethoracotomies than those with normal motor performance (p = 0.037); whereas the two groups did not differ with respect to other clinical characteristics. CONCLUSION From infancy to adolescence the motor performance in the group of EA patients deteriorated from within normal range to significantly impaired compared to reference values. Interdisciplinary follow-up programs from infancy to adolescence with close monitoring for motor function is necessary to detect motor impairments.
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Affiliation(s)
- Unn Inger Moinichen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway.
| | - Audun Mikkelsen
- Department of Paediatric Surgery, Oslo University Hospital, Postbox 4950 Nydalen, Oslo, Norway
| | - Anne Faugli
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Lars Morkrid
- University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Hanneke IJsstelstijn
- Intencive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 GD, Rotterdam, the Netherlands
| | - Ragnhild Emblem
- Department of Paediatric Surgery, Oslo University Hospital, Postbox 4950 Nydalen, Oslo, Norway; University of Oslo, Problemveien 7, 0315 Oslo, Norway
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Sreeram II, ten Kate CA, van Rosmalen J, Schnater JM, Gischler SJ, Wijnen RMH, IJsselstijn H, Rietman AB. Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies. CHILDREN-BASEL 2021; 8:children8070587. [PMID: 34356566 PMCID: PMC8307606 DOI: 10.3390/children8070587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022]
Abstract
Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.
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Affiliation(s)
- Isabel I. Sreeram
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Chantal A. ten Kate
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands;
- Department of Epidemiology, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Johannes M. Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Saskia J. Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)-10-7040209
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de Munck S, van der Cammen-van Zijp MHM, Zanen-van den Adel TPL, Wijnen RMH, Cochius-den Otter SCM, van Haren NEM, Gischler SJ, van Rosmalen J, IJsselstijn H. Persisting Motor Function Problems in School-Aged Survivors of Congenital Diaphragmatic Hernia. Front Pediatr 2021; 9:729054. [PMID: 34778130 PMCID: PMC8578794 DOI: 10.3389/fped.2021.729054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022] Open
Abstract
Background and Objectives: Children born with congenital diaphragmatic hernia (CDH) and treated with extracorporeal membrane oxygenation (ECMO), are at risk for motor function impairment during childhood. We hypothesized that all children born with CDH are at risk for persistent motor function impairment, irrespective of ECMO-treatment. We longitudinally assessed these children's motor function. Methods: Children with CDH with and without ECMO-treatment, born 1999-2007, who joined our structural prospective follow-up program were assessed with the Movement Assessment Battery for Children (M-ABC) at 5, 8, 12 years. Z-scores were used in a general linear model for longitudinal analysis. Results: We included 55 children, of whom 25 had been treated with ECMO. Forty-three (78%) were evaluated at three ages. Estimated mean (95% CI) z-scores from the general linear model were -0.67 (-0.96 to -0.39) at 5 years of age, -0.35 (-0.65 to -0.05) at 8 years, and -0.46 (-0.76 to -0.17) at 12 years. The 5- and 8-years scores differed significantly (p = 0.02). Motor development was significantly below the norm in non-ECMO treated patients at five years; -0.44 (-0.83 to -0.05), and at all ages in the ECMO-treated-patients: -0.90 (-1.32 to -0.49), -0.45 (-0.90 to -0.02) and -0.75 (-1.2 to -0.34) at 5, 8, and 12 years, respectively. Length of hospital stay was negatively associated with estimated total z-score M-ABC (p = 0.004 multivariate analysis). Conclusion: School-age children born with CDH are at risk for motor function impairment, which persists in those who received ECMO-treatment. Especially for them long-term follow up is recommended.
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Affiliation(s)
- Sophie de Munck
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | | | | | - René M H Wijnen
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suzan C M Cochius-den Otter
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Saskia J Gischler
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
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