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Dirickx M, Vermeulen F, Boon M, Debeer A, Proesmans M. Multiple breath washout measurements in school aged patients with congenital diaphragmatic hernia. Pediatr Pulmonol 2024; 59:1493-1497. [PMID: 38289110 DOI: 10.1002/ppul.26888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 04/30/2024]
Affiliation(s)
- Marlies Dirickx
- Department of General Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Heilig Hart Ziekenhuis Lier, Lier, Belgium
| | - Francois Vermeulen
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - Mieke Boon
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - Anne Debeer
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven
- Academic Department of Development and Regeneration, KU Leuven, Belgium
| | - Marijke Proesmans
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
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2
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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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3
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Yaremenko AV, Pechnikova NA, Porpodis K, Damdoumis S, Aggeli A, Theodora P, Domvri K. Association of Fetal Lung Development Disorders with Adult Diseases: A Comprehensive Review. J Pers Med 2024; 14:368. [PMID: 38672994 PMCID: PMC11051200 DOI: 10.3390/jpm14040368] [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: 02/22/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Fetal lung development is a crucial and complex process that lays the groundwork for postnatal respiratory health. However, disruptions in this delicate developmental journey can lead to fetal lung development disorders, impacting neonatal outcomes and potentially influencing health outcomes well into adulthood. Recent research has shed light on the intriguing association between fetal lung development disorders and the development of adult diseases. Understanding these links can provide valuable insights into the developmental origins of health and disease, paving the way for targeted preventive measures and clinical interventions. This review article aims to comprehensively explore the association of fetal lung development disorders with adult diseases. We delve into the stages of fetal lung development, examining key factors influencing fetal lung maturation. Subsequently, we investigate specific fetal lung development disorders, such as respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), congenital diaphragmatic hernia (CDH), and other abnormalities. Furthermore, we explore the potential mechanisms underlying these associations, considering the role of epigenetic modifications, transgenerational effects, and intrauterine environmental factors. Additionally, we examine the epidemiological evidence and clinical findings linking fetal lung development disorders to adult respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and other respiratory ailments. This review provides valuable insights for healthcare professionals and researchers, guiding future investigations and shaping strategies for preventive interventions and long-term care.
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Affiliation(s)
- Alexey V. Yaremenko
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Nadezhda A. Pechnikova
- Laboratory of Chemical Engineering A’, School of Chemical Engineering, Faculty of Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (N.A.P.); (A.A.)
- Saint Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Konstantinos Porpodis
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Savvas Damdoumis
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Amalia Aggeli
- Laboratory of Chemical Engineering A’, School of Chemical Engineering, Faculty of Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (N.A.P.); (A.A.)
| | - Papamitsou Theodora
- Laboratory of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Kalliopi Domvri
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
- Laboratory of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- Pathology Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Taillieu A, Deprest J, Vergote S, Debeer A, Russo FM, Power B, Meijer F, Crombag N. Patient-reported outcomes for congenital diaphragmatic hernia: A qualitative study. Prenat Diagn 2023; 43:339-354. [PMID: 36598028 DOI: 10.1002/pd.6303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify Patient-reported outcomes (PROs) for parents with a lived experience of a prenatal diagnosis of isolated congenital diaphragmatic hernia (CDH). METHOD Thematic analysis of in-depth interview transcripts. RESULTS Interviews (n = 26) identified 11 PROs for given time points throughout the CDH trajectory. At the time of diagnosis, acceptable quality of life was selected as relevant PRO to decide whether to continue or terminate the pregnancy. During pregnancy, (neonatal) survival chances and the eligibility for foetal therapy were prominent outcomes with foetal and maternal complications adding distress. After birth, postnatal management options became the next milestone. When survival was deemed likely, post-hospital discharge complications and future care for infant and child became important. In retrospect, impact on family, bonding, parental mental health, and parental satisfaction with care were reported as relevant outcomes. CONCLUSION PROs are relevant in addition to hard medical outcomes, as they help parents to make decisions suiting their unique needs and personal situation. Given the knowledge inherently related to the parent's perspective, our findings provide relevant directions for clinicians to support parents and their family in facing challenging decisions in healthcare. The outcomes impacting parents are essential to prepare parents for the steep journey ahead.
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Affiliation(s)
- Aymara Taillieu
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium.,Institute of Women's Health, University College London, London, UK
| | - Simen Vergote
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - Anne Debeer
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Francesca Maria Russo
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Neeltje Crombag
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Utrecht University Medical Center, Utrecht, The Netherlands
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5
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Miles KG, Powell AW, Critser PJ, Hardie W, O'Neil M, Cash M, Magness M, Geers E, Mays W, Hirsch R. Long-term exercise and pulmonary function outcomes in a contemporary cohort of children with congenital diaphragmatic hernia. Pediatr Pulmonol 2023; 58:1471-1480. [PMID: 36751101 DOI: 10.1002/ppul.26348] [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: 10/29/2022] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) survivors are at risk for long-term exercise impairment and pulmonary morbidity, but the generalizability of prior reported cohorts are limited by reduced disease severity and older surgical eras. We assessed the mid-childhood exercise and pulmonary function outcomes in a contemporary cohort of CDH survivors. STUDY DESIGN In this retrospective cohort study, we identified 36 consecutive pediatric CDH survivors who underwent cardiopulmonary exercise testing (CPET) and spirometry from 2014 to 2021. Inferential statistics compared survivors with age-, sex-, and size-matched healthy controls; univariate analyses identified factors associated with abnormal testing. RESULTS Maximal effort CPET and resting spirometry were completed by 27/36 (75%) and 31/36 (86%) subjects, respectively (median age: 8.1 years [interquartile range: 7.5, 10]; 16 females [44%]). Abnormal CPET (percent predicted [pp] peak VO2 < 80%) was more common in the CDH cohort (12 vs. 1, p < 0.001) and associated with longer neonatal intensive care unit (NICU) stay (p = 0.02) and oxygen therapy at discharge (p = 0.03). Exercise impairment was mild (pp peak VO2 70%-80%), moderate (60%-70%), and severe (<60%) in 6, 4, and 2 survivors, respectively. Abnormal spirometry was more common in the CDH cohort (21 vs. 3, p < 0.001; obstructive [n = 15], restrictive [n = 6]) and associated with decreased gestational age (p = 0.046), longer mechanical ventilation in the NICU (p = 0.02), and orthopedic abnormalities (p = 0.03). CONCLUSION(S) Exercise capacity was normal or mildly impaired in most CDH survivors, however, approximately two-thirds demonstrated abnormal spirometry. Impaired exercise capacity and lung function were associated with severity of lung disease postnatally. These data support cardiopulmonary follow-up throughout childhood.
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Affiliation(s)
- Kimberley G Miles
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam W Powell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul J Critser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - William Hardie
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meredith O'Neil
- Department of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michelle Cash
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa Magness
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth Geers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wayne Mays
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Russel Hirsch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Long term outcomes in CDH: Cardiopulmonary outcomes and health related quality of life. J Pediatr Surg 2022; 57:501-509. [PMID: 35508437 DOI: 10.1016/j.jpedsurg.2022.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/27/2022] [Accepted: 03/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND With improvements in clinical management and an increase in CDH survivorship there is a crucial need for better understanding of long-term health outcomes in CDH. AIM To investigate the prevalence of cardiopulmonary health morbidity and health related quality of life (HRQoL) in CDH survivors. METHODS We included all studies (n = 65) investigating long-term cardiopulmonary outcomes in CDH patients more than 2 years published in the last 30 years. The Newcastle-Ottawa Scale and the CASP checklist for cohort studies were utilized to assess study quality. Results were reported descriptively and collated by age group where possible. RESULTS The incidence of pulmonary hypertension was highly variable (4.5-38%), though rates (%) appeared to diminish after 5 years of age. Lung function indices and radiological outcomes were frequently abnormal, and Health Related Quality of Life (HRQoL) reduced also. Long term diseases notably emphysema and COPD are not yet fully described in the contemporary literature. CONCLUSION This study underscores cardiopulmonary health morbidity and a reduced HRQoL among CDH survivors. Where not already available dedicated multidisciplinary follow-up clinics should be established to support these vulnerable patients transition safely into adulthood. Future research is therefore needed to investigate the risk factors for cardiopulmonary ill health and morbidity in CDH survivors. TYPE OF STUDY Systematic review of case control and cohort studies.
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Hidden cardiovascular morbidity in children and young adults born with congenital diaphragmatic hernia: A population-based study. J Pediatr Surg 2022; 57:510-515. [PMID: 35501166 DOI: 10.1016/j.jpedsurg.2022.03.028] [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: 12/16/2021] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Congenital diaphragmatic (CDH) hernia is a rare congenital malformation with considerable mortality and morbidity in the neonatal period. The majority of the children today survive but little is known about long term cardiovascular morbidity. MATERIAL AND METHODS This was a nationwide population-based prospective case-control study within a cohort of Swedish children with CDH, born 1982-2015. Five controls for each patient were randomly sampled from the population. The outcomes were the corresponding International Statistical Classification of Disease (ICD) codes for cardiovascular diagnoses according to ICD 9 and 10. RESULTS There was an overrepresentation of cardiovascular diagnoses in the CDH group after one year of age compared to the control group, 8.0vs 0.5% (n = 53 versus n = 16). The risk of having a cardiovascular diagnosis in this CDH group was 15 times higher compared to the control group (HR 15.8, 95% CI: 9-27.6, p < 0.005). The diagnoses of cardiac arrhythmias and systemic hypertension were less common in the CDH group before the age of one year compared to the CDH group beyond the age of one year. Arrhythmia 3.7 vs 15.1%, systemic hypertension 3.7 vs 7.5%. CONCLUSION CDH survivors have increased cardiovascular morbidity during childhood and young adulthood. This implies that structured follow up programs, covering cardiovascular morbidity, needs to be developed and should be offered in pediatric and adult care. Being born with CDH seems to be a risk factor for future cardiovascular diagnoses. LEVEL OF EVIDENCE Level 3: Case-Control Study.
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8
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Han XY, Selesner LT, Butler MW. Congenital Diaphragmatic Hernia. Surg Clin North Am 2022; 102:739-757. [DOI: 10.1016/j.suc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9
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Gerall CD, Stewart LA, Price J, Kabagambe S, Sferra SR, Schmaedick MJ, Hernan R, Khlevner J, Krishnan US, De A, Aspelund G, Duron VP. Long-term outcomes of congenital diaphragmatic hernia: A single institution experience. J Pediatr Surg 2022; 57:563-569. [PMID: 34274078 DOI: 10.1016/j.jpedsurg.2021.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/03/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE As survival rates for patients with congenital diaphragmatic hernia (CDH) increase, long-term sequelae become increasingly prevalent. We present the outcomes of patients who underwent CDH repair at our institution and discuss standardization of follow-up care in our long-term multidisciplinary follow-up clinic. METHODS A retrospective review of patients followed in multidisciplinary clinic after CDH repair at our institution from January 1, 2005 to December 1, 2020. RESULTS A total of 193 patients met inclusion criteria, 73 females (37.8%) and 120 males (62.2%). Left-sided defects were most common (75.7%), followed by right-sided defects (20.7%). Median age at repair was 4 days (IQR 3-6) and 59.6% of all defects required patch repair. Median length of stay was 29 days (IQR 16.8-50.0). Median length of follow up was 49 months (IQR 17.8-95.3) with 25 patients followed for more than 12 years. Long-term outcomes included gastroesophageal reflux disease (42.0%), diaphragmatic hernia recurrence (10.9%), asthma (23.6%), neurodevelopmental delay (28.6%), attention deficit hyperactivity disorder (7.3%), autism (1.6%), chest wall deformity (15.5%), scoliosis (11.4%), and inguinal hernia (6.7%). CONCLUSION As survival of patients with CDH improves, long-term care must be continuously studied and fine-tuned to ensure appropriate surveillance and optimization of long-term outcomes.
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Affiliation(s)
- Claire D Gerall
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Latoya A Stewart
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Jessica Price
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Sandra Kabagambe
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Shelby R Sferra
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Maggie J Schmaedick
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Rebecca Hernan
- Division of Pediatrics, Department of Molecular Genetics. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Department of Pediatrics. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Usha S Krishnan
- Division of Pediatric Cardiology, Department of Pediatrics. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Aliva De
- Division of Pediatric Pulmonology, Department of Pediatrics. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Gudrun Aspelund
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA
| | - Vincent P Duron
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, USA.
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10
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Patel N, Massolo AC, Kraemer US, Kipfmueller F. The heart in congenital diaphragmatic hernia: Knowns, unknowns, and future priorities. Front Pediatr 2022; 10:890422. [PMID: 36052357 PMCID: PMC9424541 DOI: 10.3389/fped.2022.890422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
There is growing recognition that the heart is a key contributor to the pathophysiology of congenital diaphragmatic hernia (CDH), in conjunction with developmental abnormalities of the lung and pulmonary vasculature. Investigations to date have demonstrated altered fetal cardiac morphology, notably relative hypoplasia of the fetal left heart, as well as early postnatal right and left ventricular dysfunction which appears to be independently associated with adverse outcomes. However, many more unknowns remain, not least an understanding of the genetic and cellular basis for cardiac dysplasia and dysfunction in CDH, the relationship between fetal, postnatal and long-term cardiac function, and the impact on other parts of the body especially the developing brain. Consensus on how to measure and classify cardiac function and pulmonary hypertension in CDH is also required, potentially using both non-invasive imaging and biomarkers. This may allow routine assessment of the relative contribution of cardiac dysfunction to individual patient pathophysiological phenotype and enable better, individualized therapeutic strategies incorporating targeted use of fetal therapies, cardiac pharmacotherapies, and extra-corporeal membrane oxygenation (ECMO). Collaborative, multi-model approaches are now required to explore these unknowns and fully appreciate the role of the heart in CDH.
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Affiliation(s)
- Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Ulrike S Kraemer
- Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
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11
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Varghese NP, Tillman RH, Keller RL. Pulmonary hypertension is an important co-morbidity in developmental lung diseases of infancy: Bronchopulmonary dysplasia and congenital diaphragmatic hernia. Pediatr Pulmonol 2021; 56:670-677. [PMID: 33561308 DOI: 10.1002/ppul.25258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/30/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022]
Abstract
Bronchopulmonary dysplasia (BPD) following preterm birth and congenital diaphragmatic hernia (CDH) are both forms of developmental lung disease that may result in persistent pulmonary and pulmonary vascular morbidity in childhood. The pulmonary vascular disease (PVD) which accompanies BPD and CDH is due to developmental abnormalities and ongoing perinatal insults. This may be accompanied by evidence of elevated right heart pressures and pulmonary vascular resistance, leading to diagnosis of pulmonary hypertension (PH). The development of PH in these conditions is associated with increased morbidity and mortality in the vulnerable BPD and CDH populations. We present a review of PVD pathogenesis and evaluation in BPD and CDH and discuss management of related sequelae of PH co-morbidity for affected infants.
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Affiliation(s)
| | - Robert H Tillman
- Pediatric Pulmonary Medicine, Atrium Health, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Roberta L Keller
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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12
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Darmaun L, Lejeune S, Drumez E, Mur S, Langle‐Chevalier F, Nève V, Storme L, Michaud L, Gottrand F, Thumerelle C, Deschildre A. Quality of life was similar in children with congenital diaphragmatic hernia and oesophageal atresia and related to respiratory morbidity. Acta Paediatr 2021; 110:695-703. [PMID: 32567053 DOI: 10.1111/apa.15426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
AIM To assess quality of life (QoL) in children with congenital diaphragmatic hernia (CDH) and to compare it with oesophageal atresia (OA). METHODS A cross-sectional study in CDH children (≥7 years) was conducted in Lille University Hospital, France, from January 2013 to April 2014. History, lung function (rest, exercise) and Pediatric Quality of Life Inventory questionnaires (PedsQoL 4.0) were collected. Data of OA children were previously published. RESULTS Fifty-four CDH patients (male: 53%, median age: 11 years, IQR 9-14) were compared to 54 OA patients (male: 61%, median age: 13 years, IQR: 11-15). CDH children had significantly more frequent history of pneumonia (30% vs 13%), exercise limitation (54% vs 35%) and chest deformity (39% vs 11%); 46% had an obstructive pattern and 66% an abnormal cardiopulmonary exercise test. The median PedsQoL total score in children was 81 (IQR 73-90) in CDH and 81 (IQR 72-91) in OA (P = .8). In CDH, duration of neonatal oxygen therapy, hospitalisation for respiratory disease, exercise limitation, inhaled corticosteroids treatment, chest deformity, abnormal cardiopulmonary exercise test and lower forced expiratory volume in one second were significantly associated with lower QoL scores. CONCLUSION PedsQoL scores remained satisfactory in CDH children with CDH, with no difference compared to OA. Patients with respiratory morbidity and lung function impairment, who displayed lower scores, should be identified in order to optimise their management in reference centres.
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Affiliation(s)
- Laura Darmaun
- Paediatric Pulmonology and Allergy Unit Univ. Lille, CHU LilleHôpital Jeanne de Flandre Lille France
| | - Stephanie Lejeune
- Paediatric Pulmonology and Allergy Unit Univ. Lille, CHU LilleHôpital Jeanne de Flandre Lille France
- Univ. Lille, CHU LilleReference Centre for Rare Oesophageal DiseasesU995 ‐ LIRIC ‐ Lille Inflammation Research International Centre Lille France
| | - Elodie Drumez
- Univ. Lille, CHU LilleULR 2694 ‐ METRICS: Évaluation des technologies de santé et des pratiques médicales Lille France
| | | | - Fanny Langle‐Chevalier
- Paediatric Pulmonology and Allergy Unit Univ. Lille, CHU LilleHôpital Jeanne de Flandre Lille France
- CHU LilleReference Centre for Rare DiseaseCongenital diaphragmatic herniaHôpital Jeanne de Flandre Lille France
| | - Véronique Nève
- CHU LilleUniv. LilleUR 4483Service des Explorations Fonctionnelles Respiratoires Lille France
| | | | - Laurent Michaud
- Univ. Lille, CHU LilleReference Centre for Rare Oesophageal DiseasesU995 ‐ LIRIC ‐ Lille Inflammation Research International Centre Lille France
| | - Frederic Gottrand
- Univ. Lille, CHU LilleReference Centre for Rare Oesophageal DiseasesU995 ‐ LIRIC ‐ Lille Inflammation Research International Centre Lille France
| | - Caroline Thumerelle
- Paediatric Pulmonology and Allergy Unit Univ. Lille, CHU LilleHôpital Jeanne de Flandre Lille France
- Univ. Lille, CHU LilleReference Centre for Rare Oesophageal DiseasesU995 ‐ LIRIC ‐ Lille Inflammation Research International Centre Lille France
| | - Antoine Deschildre
- Paediatric Pulmonology and Allergy Unit Univ. Lille, CHU LilleHôpital Jeanne de Flandre Lille France
- Department of Biostatistics CHU Lille Lille France
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13
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Warncke G, Singer G, Windhaber J, Schabl L, Friehs E, Miekisch W, Gierschner P, Klymiuk I, Eber E, Zeder K, Pfleger A, Obermüller B, Till H, Castellani C. Volatile Organic Compounds, Bacterial Airway Microbiome, Spirometry and Exercise Performance of Patients after Surgical Repair of Congenital Diaphragmatic Hernia. Molecules 2021; 26:molecules26030645. [PMID: 33530644 PMCID: PMC7865878 DOI: 10.3390/molecules26030645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze the exhaled volatile organic compounds (VOCs) profile, airway microbiome, lung function and exercise performance in congenital diaphragmatic hernia (CDH) patients compared to healthy age and sex-matched controls. A total of nine patients (median age 9 years, range 6-13 years) treated for CDH were included. Exhaled VOCs were measured by GC-MS. Airway microbiome was determined from deep induced sputum by 16S rRNA gene sequencing. Patients underwent conventional spirometry and exhausting bicycle spiroergometry. The exhaled VOC profile showed significantly higher levels of cyclohexane and significantly lower levels of acetone and 2-methylbutane in CDH patients. Microbiome analysis revealed no significant differences for alpha-diversity, beta-diversity and LefSe analysis. CDH patients had significantly lower relative abundances of Pasteurellales and Pasteurellaceae. CDH patients exhibited a significantly reduced Tiffeneau Index. Spiroergometry showed no significant differences. This is the first study to report the VOCs profile and airway microbiome in patients with CDH. Elevations of cyclohexane observed in the CDH group have also been reported in cases of lung cancer and pneumonia. CDH patients had no signs of impaired physical performance capacity, fueling controversial reports in the literature.
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MESH Headings
- Acetone/analysis
- Adolescent
- Bacteria/classification
- Bacteria/genetics
- Bacteria/isolation & purification
- Child
- DNA, Bacterial/genetics
- DNA, Ribosomal/genetics
- Exercise
- Female
- Hernias, Diaphragmatic, Congenital/metabolism
- Hernias, Diaphragmatic, Congenital/physiopathology
- Hernias, Diaphragmatic, Congenital/surgery
- Herniorrhaphy/methods
- Humans
- Male
- Microbiota
- Pentanes/analysis
- Phylogeny
- RNA, Ribosomal, 16S/genetics
- Spirometry
- Vital Capacity
- Volatile Organic Compounds/analysis
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Affiliation(s)
- Gert Warncke
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
- Correspondence: ; Tel.: +43-316-385-83722
| | - Jana Windhaber
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
| | - Lukas Schabl
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
| | - Elena Friehs
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
| | - Wolfram Miekisch
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, 18057 Rostock, Germany; (W.M.); (P.G.)
| | - Peter Gierschner
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, 18057 Rostock, Germany; (W.M.); (P.G.)
| | - Ingeborg Klymiuk
- Core Facility Molecular Biology, Center for Medical Research, Medical University of Graz, 8036 Graz, Austria;
| | - Ernst Eber
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, 8036 Graz, Austria; (E.E.); (K.Z.); (A.P.)
| | - Katarina Zeder
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, 8036 Graz, Austria; (E.E.); (K.Z.); (A.P.)
| | - Andreas Pfleger
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, 8036 Graz, Austria; (E.E.); (K.Z.); (A.P.)
| | - Beate Obermüller
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
| | - Christoph Castellani
- Department of Paediatric and Adolescent Surgery, Medical University Graz, 8036 Graz, Austria; (G.W.); (J.W.); (L.S.); (E.F.); (B.O.); (H.T.); (C.C.)
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14
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Shetty S, Arattu Thodika FMS, Greenough A. Managing respiratory complications in infants and newborns with congenital diaphragmatic hernia. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1865915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Anne Greenough
- Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, London, UK
- Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK
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15
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Mizrahi D, Fardell JE, Cohn RJ, Partin RE, Howell CR, Hudson MM, Robison LL, Ness KK, McBride J, Field P, Wakefield CE, Simar D. The 6-minute walk test is a good predictor of cardiorespiratory fitness in childhood cancer survivors when access to comprehensive testing is limited. Int J Cancer 2020; 147:847-855. [PMID: 31800093 PMCID: PMC7269841 DOI: 10.1002/ijc.32819] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease is up to 10 times more likely among childhood cancer survivors compared to siblings. Low cardiorespiratory fitness is a modifiable risk-factor for cardiovascular diseases. Yet, cardiorespiratory fitness is not routinely screened in pediatric oncology, and healthy VO2max cut-points are unavailable. We aimed to predict cardiorespiratory fitness by developing a simple algorithm and establish cut-points identifying survivors' cardiovascular fitness health-risk zones. We recruited 262 childhood cancer survivors (8-18 years old, ≥1-year posttreatment). Participants completed gold-standard cardiorespiratory fitness assessment (Cardiopulmonary Exercise Test [CPET; VO2max ]) and 6-minute walk test (6MWT). Associations with VO2max were included in a linear regression algorithm to predict VO2max , which was then cross-validated. We used Bland-Altman's limits of agreement and Receiver Operating Characteristic curves using FITNESSGRAM's "Healthy Fitness Zones" to identify cut-points for adequate cardiorespiratory fitness. A total of 199 participants (aged 13.7 ± 2.7 years, 8.5 ± 3.5 years posttreatment) were included. We found a strong positive correlation between VO2max and 6MWT distance (r = 0.61, r2 = 0.37, p < 0.001). Our regression algorithm included 6MWT distance, waist-to-height ratio, age and sex to predict VO2max (r = 0.79, r2 = 0.62, p < 0.001). Forty percentages of predicted VO2max values were within ±3 ml/kg/min of measured VO2max . The cut-point for FITNESSGRAM's "health-risk" fitness zone was 39.8 ml/kg/min (males: AUC = 0.88), and 33.5 ml/kg/min (females: AUC = 0.82). We present an algorithm to reasonably predict cardiorespiratory fitness for childhood cancer survivors, using inexpensive measures. This algorithm has useful clinical application, particularly when CPET is unavailable. Our algorithm has the potential to assist clinicians to identify survivors below the cut-points with increased cardiovascular disease-risk, to monitor and refer for tailored interventions with exercise specialists.
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Affiliation(s)
- David Mizrahi
- School of Medical Sciences, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
| | - Joanna E. Fardell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Australia
| | - Richard J. Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Australia
| | - Robyn E. Partin
- Departments of Epidemiology and Cancer Control, United States of America
| | - Carrie R. Howell
- Departments of Epidemiology and Cancer Control, United States of America
| | - Melissa M. Hudson
- Departments of Epidemiology and Cancer Control, United States of America
- Oncology, St. Jude Children’s Research Hospital, Memphis, United States of America
| | - Leslie L. Robison
- Departments of Epidemiology and Cancer Control, United States of America
| | - Kirsten K. Ness
- Departments of Epidemiology and Cancer Control, United States of America
| | - Jamie McBride
- Respiratory Medicine, Sydney Children’s Hospital, Sydney, Australia
| | - Penelope Field
- Respiratory Medicine, Sydney Children’s Hospital, Sydney, Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Australia
| | - David Simar
- School of Medical Sciences, UNSW Sydney, Australia
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16
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Johnson KN, Mon RA, Gadepalli SK, Kunisaki SM. Short-term respiratory outcomes of neonates with symptomatic congenital lung malformations. J Pediatr Surg 2019; 54:1766-1770. [PMID: 30851956 DOI: 10.1016/j.jpedsurg.2019.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/17/2018] [Accepted: 01/19/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate short-term respiratory outcomes in neonates with symptomatic congenital lung malformations (CLM). METHODS Consecutive newborns who underwent surgical resection of a CLM were retrospectively reviewed. Demographic, prenatal, and outcomes data were analyzed as appropriate (p < 0.05). RESULTS Twenty-one neonates were managed at a median gestational age of 36.2 weeks [interquartile range (IQR), 33.8-39.0]. Endotracheal intubation was required in 14 (66.7%) for a median of 7.5 days [interquartile range (IQR), 3.0-25.8]. Three (14.3%) children underwent ex utero intrapartum treatment-to-resection, and another 14 (66.7%) had neonatal lung resections performed at a median age of 2.0 days (IQR, 0.08-19.5 days). Excluding one patient who received comfort care at birth, all neonates survived to hospital discharge with a median length of hospitalization of 36.5 days (IQR, 23.8-56.5). More than one-quarter were discharged on supplemental oxygen by nasal cannula. Based on a median follow up of 35.5 months (IQR, 19.0-80.8), CLM-related morbidity was still evident in 55.0%. CONCLUSION Our study suggests a high incidence of complications and chronic respiratory morbidity after neonatal lung resection for symptomatic CLMs. These data highlight the need to provide realistic expectations in perinatal counseling discussions with families and the importance of coordinating appropriate multidisciplinary follow up for these children. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kevin N Johnson
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109; Pediatric Surgical Critical Care, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109
| | - Rodrigo A Mon
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109; Pediatric Surgical Critical Care, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109; Pediatric Surgical Critical Care, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109
| | - Shaun M Kunisaki
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott, Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109.
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17
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Toussaint-Duyster LCC, van der Cammen-van Zijp MHM, Spoel M, Tiddens HAWM, Tibboel D, Wijnen RMH, van Rosmalen J, IJsselstijn H. Lung function in school-aged congenital diaphragmatic hernia patients; a longitudinal evaluation. Pediatr Pulmonol 2019; 54:1257-1266. [PMID: 31197981 PMCID: PMC6771804 DOI: 10.1002/ppul.24375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/03/2019] [Accepted: 04/23/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Children with congenital diaphragmatic hernia (CDH) are at risk for pulmonary morbidity. Data on longitudinal evaluation of lung function in CDH are scarce. We hypothesized that CDH patients would have impaired lung function that worsens over time. We evaluated lung function and its determinants at ages 8 and 12 years. METHODS Dynamic and static lung volumes, and diffusion capacity were measured. Extracorporeal membrane oxygenation (ECMO) treatment, the standardized European neonatal treatment protocol, patch repair, duration of ventilation, type of initial mechanical ventilation, and nitric oxide treatment were entered as covariates in linear mixed models with standard deviation score (SDS) lung function parameters (FEV1 , FEF 25-75 , and K CO ) as dependent variables. RESULTS Seventy-six children (27 ECMO-treated) born between 1999 and 2009 performed 113 reliable lung function tests. Severity of airflow obstruction deteriorated significantly from age 8 to 12 years: estimated mean difference (95% confidence interval [CI]) SDS FEV1 was -0.57 (-0.79 to -0.36) and SDS FEF25-75 was -0.63 (-0.89 to -0.37), both P < .001. Static lung volumes were within normal range and unchanged over time: estimated mean difference (95% CI) SDS TLC -0.27 (-0.58 to 0.04); P = .085. SDS KCO was below normal at 8 and 12 years and remained stable: -0.06 (-0.22 to 0.35); P = .648. These observations were irrespective of ECMO treatment. FEV1 and FEF25-75 were negatively associated with duration of ventilation (P < .001). Baseline data were not related with TLC or KCO. CONCLUSIONS: CDH patients should be followed into adulthood as they are at risk for worsening airflow obstruction and decreased diffusion capacity at school age, irrespective of ECMO treatment.
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Affiliation(s)
- Leontien C C Toussaint-Duyster
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Orthopedics, Section of Physical Therapy, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Monique H M van der Cammen-van Zijp
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Orthopedics, Section of Physical Therapy, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marjolein Spoel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatrics, Division of Respiratory Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rene M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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18
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Tan JK, Banton G, Minutillo C, Hall GL, Wilson A, Murray C, Nathan EA, Verheggen M, Ramsay J, Samnakay N, Dickinson J. Long-term medical and psychosocial outcomes in congenital diaphragmatic hernia survivors. Arch Dis Child 2019; 104:761-767. [PMID: 30877092 DOI: 10.1136/archdischild-2018-316091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Survival rates for congenital diaphragmatic hernia (CDH) are increasing. The long-term outcomes of CDH survivors were compared with a healthy control group to assess the morbidity for guidance of antenatal counselling and long-term follow-up programmes. PARTICIPANTS AND DESIGN Participants born with CDH in Western Australia 1993-2008 were eligible with matched controls from the general population. Participants had comprehensive lung function tests, echocardiogram, low-dose chest CT scan and completed a Strengths and Difficulties Questionnaire (SDQ) and quality of life (QOL) questionnaire. RESULTS 34 matched case-control pairs were recruited. Demographic data between groups were similar. Cases were smaller at follow-up (weight Z-score of -0.2vs0.3; p=0.03; height Z-score of -0.3vs0.6; p=0.01). Cases had lower mean Z-scores for forced expiratory volume in 1 s (FEV1) (-1.49 vs -0.01; p=0.004), FEV1/forced vital capacity (-1.92 vs -1.2; p=0.009) and forced expiratory flow at 25-75% (FEF25-75) (-1.18vs0.23; p=0.007). Cases had significantly worse respiratory mechanics using forced oscillation technique. Subpleural triangles architectural distortion, linear opacities and scoliosis on chest CT were significantly higher in cases. Prosthetic patch requirement was associated with worse lung mechanics and peak cough flow. Cases had significantly higher rates of gastro-oesophageal reflux disease (GORD) and GORD medication usage. Developmental delay was significantly higher in cases. More cases had a total difficulties score in the high to very high range (25% vs 0%, p=0.03) on the SDQ and reported lower objective QOL scores (70.2 vs 79.8, p=0.02). CONCLUSION Survivors of CDH may have significant adverse long-term medical and psychosocial issues that would be better recognised and managed in a multidisciplinary clinic.
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Affiliation(s)
- Jason K Tan
- Neonatal Intensive Care Unit, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Georgia Banton
- Children's Lung Health, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Corrado Minutillo
- Neonatal Intensive Care Unit, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University - Perth City Campus, Perth, Western Australia, Australia
| | - Andrew Wilson
- School of Physiotherapy and Exercise Science, Curtin University - Perth City Campus, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Conor Murray
- Department of Radiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Crawley, Australia
| | - Maureen Verheggen
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - James Ramsay
- Department of Cardiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Naeem Samnakay
- Division of Surgery, University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Jan Dickinson
- Division of Obstetrics and Gynaecology, University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
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19
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Toussaint-Duyster LCC, van der Cammen-van Zijp MHM, de Jongste JC, Tibboel D, Wijnen RMH, Gischler SJ, van Rosmalen J, IJsselstijn H. Congenital diaphragmatic hernia and exercise capacity, a longitudinal evaluation. Pediatr Pulmonol 2019; 54:628-636. [PMID: 30741484 PMCID: PMC6593853 DOI: 10.1002/ppul.24264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/27/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Children with congenital diaphragmatic hernia (CDH) suffer from long-term pulmonary morbidity. Longitudinal data of exercise capacity in these children are lacking. We hypothesized that exercise capacity would be impaired in children with CDH and deteriorates over time. We evaluated exercise capacity and its determinants in CDH patients longitudinally until 12 years of age. DESIGN Prospective longitudinal follow-up study in tertiary university hospital. PATIENTS One hundred and fourteen children with CDH born between 1999 and 2012. METHODS Exercise capacity was evaluated using the Bruce treadmill-protocol at the ages of 5, 8, and 12 years. Primary outcome parameter was standard deviation score (SDS) of maximal endurance time. Data were analyzed by using linear mixed models. RESULTS A total of 107 children (30 treated with extracorporeal membrane oxygenation [ECMO]) performed 191 reliable exercise tests. At ages 5, 8, and 12 years, the mean (95%CI) SDS endurance time was -0.44 (-0.65 to -0.24); -1.01 (-1.23 to -0.78); -1.10 (-1.40 to -0.80), respectively, all less than zero (P < 0.001). Exercise capacity declined significantly over time irrespective of ECMO-treatment (5-12 years: non-ECMO P = 0.015; ECMO P = 0.006). Duration of initial hospital stay and diffusion capacity corrected for alveolar volume were associated with SDS endurance time (P < 0.001 and P = 0.039). CONCLUSIONS In CDH patients exercise capacity deteriorates between 5 and 12 years of age, irrespective of ECMO-treatment. CDH patients may benefit from long-term assessments of exercise capacity with timely intervention.
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Affiliation(s)
- Leontien C C Toussaint-Duyster
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Orthopedics, Section of Physical Therapy, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique H M van der Cammen-van Zijp
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Orthopedics, Section of Physical Therapy, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rene M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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20
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El Chehadeh K, Becmeur F, Weiss L. [Medium and long-term respiratory outcome in patients operated from congenital diaphragmatic hernia: From a series of 56 patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:467-482. [PMID: 30473223 DOI: 10.1016/j.pneumo.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/30/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Recent advances in prenatal diagnosis, high frequency oscillatory ventilation and pulmonary arterial hypertension (PAH) therapies have progressively improved the survival of patients with congenital diaphragmatic hernia (CDH). However, CDH is associated with high morbidity that affects about half of surviving children. The main sequelae observed are respiratory (asthma, persistent PAH [PPAH], bronchopulmonary dysplasia, respiratory infections) and digestive (gastroesophageal reflux disease [GERD]). METHOD This retrospective study focuses on the medium and long-term respiratory evolution of a cohort of 56 children with CDH and operated at Strasbourg University Hospital between 1999 and 2017. RESULTS The mean age at assessment was 6,6 years (minimum: 5 months; maximum: 19 years). Seventeen patients (30 %) had asthmatic manifestations. Pulmonary Function Tests (PFT) showed obstructive patterns in 5/11 patients (2 with post-bronchodilator reversibility), and restrictive impairment in 5/11 patients, 3 of whom had thoracic deformity and/or scoliosis. Thirteen patients (23 %) had bronchopulmonary dysplasia. Few patients had recurrent respiratory infections (3.6 %) and chronic respiratory insufficiency (5.3 %). Thirty-nine patients (70 %) presented with an initial PAH, two of whom progressed to PPAH. Sixteen patients (29 %) had thoracic deformity and/or scoliosis and 48 patients (86 %) had GERD, 10 of whom had fundoplication. CONCLUSION The long-term respiratory outcome of CDH operated patients is characterized by a moderate prevalence of respiratory symptoms and alterations in PFT that are important to consider in their medical follow-up during adolescence and adulthood. PAH is common in the neonatal period but rarely seems to persist.
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Affiliation(s)
- K El Chehadeh
- Service d'allergologie, d'asthmologie et de pathologie respiratoire de l'environnement, pôles des pathologies thoraciques, CHU de Strasbourg, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - F Becmeur
- Service de chirurgie pédiatrique, pôle médicochirurgical de pédiatrie, CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - L Weiss
- Service de pédiatrie et CRCM, pôle médicochirurgical de pédiatrie, CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
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21
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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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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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Öst E, Nisell M, Frenckner B, Mesas Burgos C, Öjmyr-Joelsson M. Parenting stress among parents of children with congenital diaphragmatic hernia. Pediatr Surg Int 2017; 33:761-769. [PMID: 28527042 PMCID: PMC5486636 DOI: 10.1007/s00383-017-4093-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to examine parental stress among parents of children with congenital diaphragmatic hernia (CDH). METHODS Between 2005 and 2009, a total of 51 children with CDH were treated at Astrid Lindgren Children's Hospital. The survival rate at discharge was 86% and long-term survival rate 80%. One parent each of the long-term survivors (41 children) was included in the present study, and 34 parents (83%) agreed to participate. Participants received the Swedish Parenthood Stress Questionnaire (SPSQ). The questionnaire was supplemented by data from case records. RESULTS Parents of children with CDH, who had been supported by ECMO or had a long hospital stay, showed significantly higher overall parental stress. Mothers scored an overall higher parental stress compared with fathers. A prenatal diagnosis of CDH or lower parental educational level resulted in significantly higher parental stress in some of the factors. CONCLUSIONS Parental stress in parents of children with CDH seems to increase with the severity of the child's malformation. Mothers tend to score higher parental stress than fathers.
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Affiliation(s)
- Elin Öst
- Karolinska Institutet, Department of Women’s and Children’s Health, 171 76 Stockholm, Sweden ,Pediatric Surgery Unit, Karolinska University Hospital, Astrid Lindgren Children’s Hospital, 171 76 Stockholm, Sweden
| | | | - Björn Frenckner
- Karolinska Institutet, Department of Women’s and Children’s Health, 171 76 Stockholm, Sweden ,Pediatric Surgery Unit, Karolinska University Hospital, Astrid Lindgren Children’s Hospital, 171 76 Stockholm, Sweden
| | - Carmen Mesas Burgos
- Karolinska Institutet, Department of Women’s and Children’s Health, 171 76 Stockholm, Sweden ,Pediatric Surgery Unit, Karolinska University Hospital, Astrid Lindgren Children’s Hospital, 171 76 Stockholm, Sweden
| | - Maria Öjmyr-Joelsson
- Karolinska Institutet, Department of Women’s and Children’s Health, 171 76 Stockholm, Sweden ,Pediatric Surgery Unit, Karolinska University Hospital, Astrid Lindgren Children’s Hospital, 171 76 Stockholm, Sweden
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Bojanić K, Woodbury JM, Cavalcante AN, Grizelj R, Asay GF, Colby CE, Carey WA, Schears GJ, Weingarten TN, Schroeder DR, Sprung J. Congenital diaphragmatic hernia: outcomes of neonates treated at Mayo Clinic with and without extracorporeal membrane oxygenation. Paediatr Anaesth 2017; 27:314-321. [PMID: 28211131 DOI: 10.1111/pan.13046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a rare anomaly with high mortality and long-term comorbid conditions. AIMS Our aim was to describe the presenting characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution. METHODS We performed a retrospective cohort study and identified consecutive neonates treated for CDH from 2001 to 2015 at our institution. For all patients identified, we reviewed hospital and postdischarge data for neonatal, disease, and treatment characteristics. We determined hospital survival overall and also according to the presence of prenatal diagnosis, liver herniation into the chest (liver up), and the use of extracorporeal membrane oxygenation (ECMO) in addition to surgery. We evaluated postdischarge chronic conditions in patients with at least one year of follow-up. RESULTS Thirty-eight neonates were admitted for treatment during the study period. In three who were in extremis, life support was withdrawn. The other 35 underwent surgical repair, of whom eight received ECMO. The overall survival was 79% (30/38). Survival for those who had surgical correction of CDH but did not need ECMO was 89% (24/27); it was 75% (6/8) for those who received ECMO and had surgery. Hospital survival was lower for liver-up vs liver-down CDH (61% [11/18] vs 95% [19/20]; odds ratio, 0.08; 95% CI, 0.01-0.77; P = 0.01). Among survivors, the median duration of hospitalization was 31 (interquartile range, 20-73) days. Major chronic pulmonary and gastrointestinal disorders, failure to thrive, and neurodevelopmental delays were the most noted comorbid conditions after discharge, and all were more prevalent in those who required ECMO. CONCLUSION The overall survival of neonates with CDH was 79%. Intrathoracic liver herniation was associated with more frequent use of ECMO and greater mortality. A substantial number of survivors, especially those who required ECMO, experienced chronic conditions after discharge.
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Affiliation(s)
- Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | | | | | - Ruža Grizelj
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Garth F Asay
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher E Colby
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - William A Carey
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
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Bojanić K, Grizelj R, Dilber D, Šarić D, Vuković J, Pianosi PT, Driscoll DJ, Weingarten TN, Pritišanac E, Schroeder DR, Sprung J. Cardiopulmonary exercise performance is reduced in congenital diaphragmatic hernia survivors. Pediatr Pulmonol 2016; 51:1320-1329. [PMID: 27228382 DOI: 10.1002/ppul.23481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia. CDH survivors may have pulmonary morbidity that can decrease cardiopulmonary exercise. We aimed to examine whether cardiopulmonary exercise testing (CPET) results differ in CDH survivors versus healthy age-matched controls and whether CPET results among CDH survivors differ according to self-reported daily activity. METHODS In one medical center in Croatia, CDH survivors-patients with surgically corrected CDH who were alive at age 5 years-were invited to participate in spirometry and CPET. Values were compared with those of controls matched 2:1 by age and sex for each CDH survivor aged 7 years or older. RESULTS Among 27 CDH survivors aged 5-20 years, 13 (48%) had continued symptoms or spirometric evidence of pulmonary disease. Compared with controls (n = 44), survivors (n = 22) had lower peak oxygen consumption (V˙O2 mean [SD], 35.7 [6.9] vs. 45.3 [8.2] ml/kg per min; P < 0.001). At peak exercise, V˙O2/heart rate (P < 0.001), tidal volume (P = 0.005), and minute ventilation (P < 0.001) were lower in survivors, but the maximal respiratory rate was not different (P = 0.72). Among survivors, mean (SD) V˙O2peak (ml/kg per min) differed by self-reported activity level: athletic, 40.3 (5.0); normal, 35.8 (6.5); and sedentary, 32.1 (6.8) (by ANOVA, P = 0.10 across three groups and P = 0.04 athletic vs. sedentary). CONCLUSION More than half of CDH survivors continue to have chronic pulmonary disease. CDH survivors had lower aerobic exercise capacity than controls. Self-reporting information on daily activities may identify CDH patients with low V˙O2max who may benefit from physical training. Pediatr Pulmonol. 2016;51:1320-1329. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Ruža Grizelj
- Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Daniel Dilber
- Division of Pediatric Cardiology, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Dalibor Šarić
- Division of Pediatric Cardiology, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Jurica Vuković
- Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Paolo T Pianosi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - David J Driscoll
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester 55905, Minnesota
| | - Ena Pritišanac
- Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester 55905, Minnesota
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Wessel LM, Fuchs J, Rolle U. The Surgical Correction of Congenital Deformities: The Treatment of Diaphragmatic Hernia, Esophageal Atresia and Small Bowel Atresia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:357-64. [PMID: 26051693 DOI: 10.3238/arztebl.2015.0357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND More than half of all congenital deformities can be detected in utero. The initial surgical correction is of paramount importance for the achievement of good long-term results with low surgical morbidity and mortality. METHODS Selective literature review and expert opinion. RESULTS Congenital deformities are rare, and no controlled trials have been performed to determine their optimal treatment. In this article, we present the prenatal assessment, treatment, and long-term results of selected types of congenital deformity. Congenital diaphragmatic hernia (CDH) affects one in 3500 live-born infants, while esophageal atresia affects one in 3000 and small-bowel atresia one in 5000 to 10,000. If a congenital deformity is detected and its prognosis can be reliably inferred from a prenatal assessment, the child should be delivered at a specialized center (level 1 perinatal center). The associated survival rates are 60-80% after treatment for CDH and well over 90% after treatment for esophageal or small-bowel atresia. Despite improvements in surgical correction over the years, complications and comorbidities still affect 20-40% of the treated children. These are not limited to surgical complications in the narrow sense, such as recurrence, postoperative adhesions and obstruction, stenoses, strictures, and recurrent fistulae, but also include pulmonary problems (chronic lung disease, obstructive and restrictive pulmonary dysfunction), gastrointestinal problems (dysphagia, gastro-esophageal reflux, impaired intestinal motility), and failure to thrive. Moreover, the affected children can develop emotional and behavioral disturbances. Minimally invasive surgery in experienced hands yields results as good as those of conventional surgery, as long as proper selection criteria are observed. CONCLUSION Congenital deformities should be treated in recognized centers with highly experienced interdisciplinary teams. As no randomized trials of surgery for congenital deformities are available, longitudinal studies and registries will be very important in the future.
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Affiliation(s)
- Lucas M Wessel
- Department of Pediatric Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Campus Niederrad,Frankfurt am Main
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Healy F, Lin W, Feng R, Hanna BD, Hedrick H, Panitch HB. An association between pulmonary hypertension and impaired lung function in infants with congenital diaphragmatic hernia. Pediatr Pulmonol 2015; 50:672-82. [PMID: 24623605 DOI: 10.1002/ppul.23035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/16/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
RATIONALE Infants with congenital diaphragmatic hernia (CDH) can develop pulmonary hypertension (PH) from decreased number and abnormal muscularization of pulmonary arteries. Normally pulmonary vascular growth and remodeling parallel airspace growth and alveolarization, which exhibits a wide morphologic variation in CDH. AIM To assess whether infants with CDH and PH have greater abnormalities in infant pulmonary function testing (IPFT) compared to those without PH. METHODS We reviewed results of IPFTs and echocardiograms performed on infants with CDH from 2004 to June 2011. Lung volumes, forced flows and tidal mechanics were standardized according to available reference values. Comparisons between infants with and without PH were performed using linear regression, adjusting for potential confounders. MAIN RESULTS Sixty-six infants were included; 18 had PH and 48 did not. Z-score values for functional residual capacity (FRC), residual volume (RV), FRC/total lung capacity (TLC), and RV/TLC were significantly higher in infants with CDH and PH compared to those without PH. Z-score values for forced flows including forced expiratory volume in the first 0.5 sec (FEV0.5) and FEV0.5/forced vital capacity were significantly lower in infants with CDH and PH compared to those without PH. For 29 infants studied on ≥2 occasions, the slopes of FRC, RV, and TLC versus length were significantly higher in those with persistent PH compared to those without. CONCLUSIONS Infants with CDH and persistent PH demonstrate greater airspace overdistension with growth compared to those without. Therapies that modify disrupted pulmonary vascular and alveolar formation could potentially improve future care of these patients.
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Affiliation(s)
- Fiona Healy
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wei Lin
- Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rui Feng
- Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Brian D Hanna
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly Hedrick
- Department of General Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Howard B Panitch
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Spoel M, van der Cammen-van Zijp MHM, Hop WCJ, Tibboel D, de Jongste JC, Ijsselstijn H. Lung function in young adults with congenital diaphragmatic hernia; a longitudinal evaluation. Pediatr Pulmonol 2013; 48:130-7. [PMID: 22451263 DOI: 10.1002/ppul.22557] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/27/2012] [Accepted: 02/27/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Survival rates of patients with congenital diaphragmatic hernia (CDH) have improved to up to 80%. Little is known about long-term consequences of the disease and its treatment. We evaluated lung function and respiratory symptoms longitudinally in a previously studied cohort of CDH patients and age-matched non-CDH patients who underwent similar neonatal intensive care treatment. STUDY DESIGN We tested 27 young adults [mean (SD) age: 26.8 years (2.9)] with CDH and 30 non-CDH patients. Dynamic and static lung volumes, midexpiratory flows, and diffusion capacity were expressed as mean (SD) standard deviation scores. Prevalence of respiratory symptoms was evaluated with the European Community Respiratory Health Survey. RESULTS All data are expressed as mean (SD). FEF(25-75) in CDH patients had slightly deteriorated since childhood (CDH: -0.7 (1.4) vs. -1.6 (1.5), P < 0.001; non-CDH patients: 0.2 (1.4) vs. -0.3 (1.6), P = 0.038, ns). Diffusion capacity decreased in both groups (CDH: DL(CO) c 0.2 (1.1) vs. -1.5 (1.1), P <0.001; non-CDH: DL(CO) c 0.1 (0.4) vs. -1.1 (1.1), P < 0.001). Lung volumes were normal in both groups. The prevalence of asthma was higher than in the normal population (27.6% in patients and 30% in controls, P < 0.001). CONCLUSIONS Airflow obstruction and diffusion capacity deteriorated mildly from childhood into adulthood in survivors of CDH. The improved survival of patients with more severe forms of diaphragmatic hernia calls for long-term follow-up of lung function.
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Affiliation(s)
- Marjolein Spoel
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
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Egan MJ, Husain N, Stines JR, Moiduddin N, Stein MA, Nelin LD, Cua CL. Mid-term differences in right ventricular function in patients with congenital diaphragmatic hernia compared with controls. World J Pediatr 2012; 8:350-4. [PMID: 23151863 DOI: 10.1007/s12519-012-0380-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/04/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with congenital diaphragmatic hernia (CDH) may have abnormal lung development, which may cause detrimental effects on right ventricular (RV) function. This study aimed to determine if there are persistent echocardiographic differences in RV function in patients with CDH years after repair versus control patients. METHODS Patients who underwent repair for CDH were recruited. RV function was evaluated by strain analysis and tissue Doppler imaging (TDI). Wilcoxon's rank-sum test was used for analysis. RESULTS Seven CDH patients and 16 control patients were studied. There was no difference in age between the CDH and control groups (6.2±1.7 years vs. 5.7±1.7 years). TDI demonstrated significantly lower values in the RV early diastolic wave (12.8±1.5 cm/s vs. 16.1±3.1 cm/s) and RV systolic wave (10.2± 0.8cm/s vs. 13.4±1.3 cm/s) when comparing the CDH group and the control group. Interventricular apical septal strain was signifi cantly lower in the CDH group than in the control group (-20.1±4.6% vs. -25.4±4.1%). There was a trend towards lower strain values in the RV mid-lateral segment in the CDH group (-30.8±9.9% versus -39.7±6.0%, P=0.06) and a lower global RV strain (-27.8±3.0% vs. -31.1±3.1%, P=0.06). CONCLUSIONS Patients who underwent CDH repair continue to have differences in RV function years after repair. Follow-up is needed to determine how these differences impact cardiac function in adult survivors of CDH.
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Affiliation(s)
- Matthew J Egan
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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Prendergast M, Rafferty GF, Milner AD, Broughton S, Davenport M, Jani J, Nicolaides K, Greenough A. Lung function at follow-up of infants with surgically correctable anomalies. Pediatr Pulmonol 2012; 47:973-8. [PMID: 22328362 DOI: 10.1002/ppul.22515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/13/2011] [Indexed: 11/07/2022]
Abstract
Infants with congenital diaphragmatic hernia (CDH) or anterior wall defects (AWD) can suffer abnormal antenatal lung growth, the risk, however, may be greater for CDH infants. The objectives of this study were to test the hypothesis that following surgical correction, CDH infants would have worse lung function at follow-up than AWD infants and to determine whether fetal lung volume (FLV) results correlated with the lung function results at follow-up. Thirteen infants with CDH and 13 infants with AWD had lung function measurements at a median age of 11 (range 6-24) months; 17 of the infants had had their FLV assessed. Lung function was assessed by plethysmographic measurement of lung volume (FRCpleth) and airway resistance (Raw). In addition, functional residual capacity was assessed by a helium gas dilution technique (FRCHe); tidal breathing parameters (T(PTEF) :Te) and compliance and resistance of the respiratory system (Crs and Rrs, respectively) were also determined. FLV was assessed using three-dimensional (3D) ultrasound and virtual organ computer aided analysis. The CDH compared to the AWD infants had a higher median FRCpleth (41 ml/kg vs. 37 ml/kg, P = 0.043) and a lower median Crs (1.45 ml/cm H(2) O/kg vs. 2.78 ml/cm H(2) O/kg, P = 0.041). FRCpleth results correlated significantly with FLV results (r = 0.721, P < 0.001). In conclusion, infants with CDH had significantly different lung function at follow-up than AWD infants. Our findings suggest FLV results may predict lung function abnormalities at follow-up in infants with surgically correctable anomalies.
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Affiliation(s)
- Michael Prendergast
- Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, United Kingdom
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Grosu HB, Killam J, Khusainova E, Lozada J, Needelman A, Eden E. Genetic, host, and environmental interactions in a 19 year old with severe chronic obstructive lung disease; observations regarding the pathophysiology of airflow obstruction. Int J Chron Obstruct Pulmon Dis 2012; 7:383-7; quiz 388. [PMID: 22791992 PMCID: PMC3393337 DOI: 10.2147/copd.s30325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A case of a 19-year-old with severe chronic obstructive pulmonary disease is presented. This case illustrates genetic (severe alpha-1 antitrypsin deficiency) and host factors (such as developmental diaphragmatic hernia and the innate response to injury), and environmental (high oxidative stress and lung injury) interactions that lead to severe chronic obstructive lung disease. The development of chronic lung disease was caused by lung injury under high oxidative and inflammatory conditions in the setting of a diaphragmatic hernia. In the absence of normal alpha-1 antitrypsin levels, a pro-elastolytic environment in the early period of lung growth enhanced the development of severe hyperinflation and precocious airflow obstruction.
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Affiliation(s)
- Horiana B Grosu
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Radiology, St Luke's Roosevelt Hospital Center, New York, NY 10019, USA
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van der Cammen-van Zijp MHM, Spoel M, Laas R, Hop WCJ, de Jongste JC, Tibboel D, van den Berg-Emons RJG, IJsselstijn H. Exercise capacity, daily activity, and severity of fatigue in term born young adults after neonatal respiratory failure. Scand J Med Sci Sports 2012; 24:144-51. [PMID: 22724460 DOI: 10.1111/j.1600-0838.2012.01491.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2012] [Indexed: 11/30/2022]
Abstract
Little is known about long-term effects of neonatal intensive care on exercise capacity, physical activity, and fatigue in term borns. We determined these outcomes in 57 young adults, treated for neonatal respiratory failure; 27 of them had congenital diaphragmatic hernia with lung hypoplasia (group 1) and 30 had normal lung development (group 2). Patients in group 2 were age-matched, with similar gestational age and birth weight, and similar neonatal intensive care treatment as patients in group 1. All patients were born before the era of extracorporeal membrane oxygenation, nitric oxide administration, and high frequency ventilation. Exercise capacity was measured by cycle ergometry, daily physical activity with an accelerometry-based activity monitor, and fatigue by the fatigue severity scale. Median (range) VO2peak in mL/kg/min was 35.4 (19.6-55.0) in group 1 and 37.6 (15.7-52.7) in group 2. There was a between-group P-value of 0.65 for exercise capacity. Daily activity and fatigue were also similar in both groups. So, residual lung hypoplasia did not play an important role in this cohort. There were no significant associations between exercise capacity and perinatal characteristics. Future studies need to elucidate whether exercise capacity is impaired in patients with more severe lung hypoplasia who nowadays survive.
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Affiliation(s)
- M H M van der Cammen-van Zijp
- Intensive Care and Department of Pediatric Surgery, and Department of Rehabilitation Medicine and Physical Therapy, ErasmusMC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Veenma DCM, de Klein A, Tibboel D. Developmental and genetic aspects of congenital diaphragmatic hernia. Pediatr Pulmonol 2012; 47:534-45. [PMID: 22467525 DOI: 10.1002/ppul.22553] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 02/17/2012] [Indexed: 12/21/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a frequent occurring cause of neonatal respiratory distress and occurs 1 in every 3,000 liveborns. Ventilatory support and pharmaceutical treatment of the co-occurring lung hypoplasia and pulmonary hypertension are insufficient in, respectively, 20% of isolated cases and 60% of complex ones leading to early perinatal death. The exact cause of CDH remains to be identified in the majority of human CDH patients and prognostic factors predicting treatment refraction are largely unknown. Their identification is hampered by the multifactorial and heterogenic nature of this congenital anomaly. However, application of high-resolution molecular cytogenetic techniques to patients' DNA now enables detection of chromosomal aberrations in 30% of the patients. Furthermore, recent insights in rodent embryogenesis pointed to a specific disruption of the early mesenchymal structures in the primordial diaphragm of CDH-induced offspring. Together, these data allowed for the introduction of new hypotheses on CDH pathogenesis, although many issues remain to be resolved. In this review, we have combined these new insights and remaining questions on diaphragm pathogenesis with a concise overview of the clinical, embryological, and genetic data available.
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Affiliation(s)
- D C M Veenma
- Department of Paediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands
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Prospective longitudinal evaluation of lung function during the first year of life after repair of congenital diaphragmatic hernia. Pediatr Crit Care Med 2012; 13:e133-9. [PMID: 21666527 DOI: 10.1097/pcc.0b013e3182231872] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate lung function and respiratory morbidity prospectively during the first year of life in patients with congenital diaphragmatic hernia and to study the effect of extracorporeal membrane oxygenation therapy. DESIGN Prospective longitudinal cohort study. SETTING Outpatient clinic of a tertiary-level pediatric hospital. PATIENTS The cohort of 43 infants included 12 patients treated with extracorporeal membrane oxygenation. Evaluation was at 6 and 12 months; 33 infants were evaluated at both time points. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Maximal expiratory flow at functional residual capacity and functional residual capacity were measured with Masterscreen Babybody. Z-scores were calculated for maximal expiratory flow at functional residual capacity. Mean maximal expiratory flow at functional residual capacity values at 6 and 12 months were significantly below the expected values (mean z-score -1.4 and -1.5, respectively) without a significant change between both time points. Values did not significantly differ between extracorporeal membrane oxygenation and nonextracorporeal membrane oxygenation-treated patients. Functional residual capacity values were generally high, 47% were above the suggested normal range, and did not change significantly over time. Mean functional residual capacity values in extracorporeal membrane oxygenation-treated patients were significantly higher than in nonextracorporeal membrane oxygenation-treated patients (p = .006). The difference (5.1 mL/kg ± 1.8 SE) did not change significantly between the two time points. Higher mean airway pressure and longer duration of ventilation were associated with higher functional residual capacity. None of the perinatal characteristics was associated with maximal expiratory flow at functional residual capacity. Mean weight z-scores were significantly below zero at both time points (p < .001). Mean weight z-score in extracorporeal membrane oxygenation-treated patients were lower than in nonextracorporeal membrane oxygenation-treated patients (p = .046). CONCLUSIONS Infants with congenital diaphragmatic hernia have decreased expiratory flows and increased functional residual capacity within the first year of life. Extracorporeal membrane oxygenation-treated patients with congenital diaphragmatic hernia may have more respiratory morbidity and concomitant growth impairment. Close follow-up beyond the neonatal period is therefore required.
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Manzoni P, Paes B, Resch B, Carbonell-Estrany X, Bont L, Carbonell-Estrany X, Bont L. High risk for RSV bronchiolitis in late preterms and selected infants affected by rare disorders: a dilemma of specific prevention. Early Hum Dev 2012; 88 Suppl 2:S34-41. [PMID: 22633511 DOI: 10.1016/s0378-3782(12)70012-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Respiratory syncytial virus (RSV) is the most frequent aetiologic agent that causes bronchiolitis and lower respiratory tract infection in infants. These infections may be severe and even life-threatening in selected high-risk populations. Traditional, well-established, high-risk populations are preterm infants with or without chronic lung disease and children with congenital heart disease. For these children, RSV prophylaxis using palivizumab, a monoclonal anti-RSV humanised antibody against the F-protein of RSV, has proven safe and efficacious in preventing RSV-related hospitalisation. Recently, a number of rare medical conditions have been associated with the risk of severe RSV infections. Evidence of safety and efficacy of RSV prophylaxis in these populations is lacking. Given the low incidence of these conditions, randomised trials are not feasible. A practical, opinion-based approach to this dilemma is offered in this paper. It is proposed that these rare disorders may qualify for RSV prophylaxis if the association between a specific condition and the risk of severe RSV infection is confirmed in at least 3 independent publications, of which at least 1 includes a prospective cohort study. To facilitate pharmaco-economic analyses, at least one of the three studies must also report on the absolute risk of severe RSV infection in the specified illness. The authors believe that qualification criteria will enable caregivers to target RSV prophylaxis more effectively in children with rare conditions and the proposed approach provides direction for future epidemiological studies on the risk of severe RSV infection in children with these uncommon, medical illnesses.
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Affiliation(s)
- P Manzoni
- Neonatology and NICU, S Anna Hospital, ASO OI Regina Margherita-S Anna, Torino, Italy.
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Delacourt C, Hadchouel A, Toelen J, Rayyan M, de Blic J, Deprest J. Long term respiratory outcomes of congenital diaphragmatic hernia, esophageal atresia, and cardiovascular anomalies. Semin Fetal Neonatal Med 2012; 17:105-11. [PMID: 22297025 DOI: 10.1016/j.siny.2012.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intrathoracic congenital malformations may be associated with long-term pulmonary morbidity. This certainly is the case for congenital diaphragmatic hernia, esophageal atresia and cardiac and aortic arch abnormalities. These conditions have variable degrees of impaired development of both the airways and lung vasculature, with a postnatal impact on lung function and bronchial reactivity. Pulmonary complications are themselves frequently associated to non-pulmonary morbidities, including gastrointestinal and orthopaedic complications. These are best recognized in a structured multidisciplinary follow-up clinic so that they can be actively managed.
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van den Hout L, Tibboel D, Vijfhuize S, te Beest H, Hop W, Reiss I. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial. BMC Pediatr 2011; 11:98. [PMID: 22047542 PMCID: PMC3226543 DOI: 10.1186/1471-2431-11-98] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 11/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly of the diaphragm resulting in pulmonary hypoplasia and pulmonary hypertension. It is associated with a high risk of mortality and pulmonary morbidity. Previous retrospective studies have reported high frequency oscillatory ventilation (HFO) to reduce pulmonary morbidity in infants with CDH, while others indicated HFO to be associated with worse outcome. We therefore aimed to develop a randomized controlled trial to compare initial ventilatory treatment with high-frequency oscillation and conventional ventilation in infants with CDH. METHODS/DESIGN This trial is designed as a multicentre trial in which 400 infants (200 in each arm) will be included. Primary outcome measures are BPD, described as oxygen dependency by day 28 according to the definition of Jobe and Bancalari, and/or mortality by day 28. All liveborn infants with CDH born at a gestational age of over 34 weeks and no other severe congenital anomalies are eligible for inclusion. Parental informed consent is asked antenatally and the allocated ventilation mode starts within two hours after birth. Laboratory samples of blood, urine and tracheal aspirate are taken at the first day of life, day 3, day 7, day 14 and day 28 to evaluate laboratory markers for ventilator-induced lung injury and pulmonary hypertension. DISCUSSION To date, randomized clinical trials are lacking in the field of CDH. The VICI-trial, as the first randomized clinical trial in the field of CDH, may provide further insight in ventilation strategies in CDH patient. This may hopefully prevent mortality and morbidity. TRIAL REGISTRATION Netherlands Trial Register (NTR): NTR1310.
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Affiliation(s)
- Lieke van den Hout
- Intensive care and Department of Pediatric Surgery, Erasmus MC - Sophia, Dr. Molewaterplein 50, 3015 GE, Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive care and Department of Pediatric Surgery, Erasmus MC - Sophia, Dr. Molewaterplein 50, 3015 GE, Rotterdam, the Netherlands
| | - Sanne Vijfhuize
- Intensive care and Department of Pediatric Surgery, Erasmus MC - Sophia, Dr. Molewaterplein 50, 3015 GE, Rotterdam, the Netherlands
| | - Harma te Beest
- Intensive care and Department of Pediatric Surgery, Erasmus MC - Sophia, Dr. Molewaterplein 50, 3015 GE, Rotterdam, the Netherlands
| | - Wim Hop
- Department of biostatistics, ErasmusMC, Dr. Molewaterplein 50, 3015 GE, Rotterdam, the Netherlands
| | - Irwin Reiss
- Intensive care and Department of Pediatric Surgery, Erasmus MC - Sophia, Dr. Molewaterplein 50, 3015 GE, Rotterdam, the Netherlands
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Turchetta A, Fintini D, Cafiero G, Calzolari A, Giordano U, Cutrera R, Morini F, Braguglia A, Bagolan P. Physical activity, fitness, and dyspnea perception in children with congenital diaphragmatic hernia. Pediatr Pulmonol 2011; 46:1000-6. [PMID: 21520442 DOI: 10.1002/ppul.21471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 01/28/2011] [Accepted: 02/21/2011] [Indexed: 11/08/2022]
Abstract
We assessed whether physical activity could influence the performance and perception of dyspnea in children who were operated on for high risk congenital diaphragmatic hernia (CDH). We hypothesized that CDH children with normal activity would have better lung function and exercise performance level when compared to sedentary CDH subjects. We studied 18 children (11 males and 7 females, mean age 6.6 ± 2.6 years) who were surgically corrected. All children underwent physical examination, ECG at rest, and a maximal exercise stress test on a treadmill to measure the duration of exercise, maximal heart rate and blood pressure, maximal oxygen uptake (VO(2) max and VO(2) ml/kg/min). Lung function testing to measure forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV(1) ), and peak expiratory flow (PEF) was also performed. Following the stress test, the Dalhousie dyspnea and effort scale was shown to children as a pictorial panel with three groups of increasing (from 1 to 7) levels of effort perception, throat discomfort, and chest dyspnea. Children were divided into group A (sedentary) and group B (regular physical participation). There was no difference in CDH severity between the two groups. Group A had a statistically significant lower duration of exercise (P < 0.01), maximal oxygen consumption (VO(2) max P < 0.0001), VO(2) ml/kg/min (P < 0.001), higher throat closing feeling (P < 0.004), chest dyspnea (P < 0.001), and effort perception (P < 0.04) compared to group B. No differences were found in lung function tests. In conclusion, our data may suggest that children with a history of CDH who are active maintain a higher level of performance with less perception of dyspnea and effort.
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Affiliation(s)
- Attilio Turchetta
- Cardiorespiratory and Sport Medicine Unit, Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy.
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Goetz DM, Burns C, Segura BJ, Weiner DJ. Late presentation of congenital diaphragmatic hernia in patients with cystic fibrosis. Pediatr Pulmonol 2010; 45:403-5. [PMID: 20054862 DOI: 10.1002/ppul.21173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Late presentation of congenital diaphragmatic hernia (CDH) is unusual, especially in patients with cystic fibrosis (CF). To our knowledge, cases of CDH in CF patients and the combined effects on lung function have not been previously described. Here we report two cases of late presenting CDH in CF patients and describe effects on lung function. Late presentation of CDH in CF patients can cause gastrointestinal or respiratory symptoms and requires a high index of suspicion as well as proper interpretation of imaging. In patients with CF and CDH, lung function abnormalities could include obstructive, restrictive defects, or combined defects.
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Affiliation(s)
- Danielle M Goetz
- Division of Pulmonary Medicine, Department of Pediatrics, The Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15201, USA.
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