Preschool neurological assessment in congenital diaphragmatic hernia survivors: Outcome and perinatal factors associated with neurodevelopmental impairment

ObjectivePrevious outcome reports of congenital diaphragmatic hernia (CDH) have described neuroimaging anomalies and neurodevelopmental impairment. However, the link between imaging and outcome has not been described. We aimed to determine whether routine postoperative neonatal neuroimaging in infants with CDH detects later neurodevelopmental impairment.MethodsIn a prospective cohort study within a clinical service in The Royal Children’s Hospital Newborn Intensive Care. Cerebral ultrasound was performed in 81 children and MRI in 57 children who subsequently underwent neurodevelopmental follow-up after surgery for CDH. MRI scans were analyzed using a scoring system designed to identify injury, maturation and volume loss. Neurodevelopmental assessment occurred at 2 years (48) and neurocognitive assessment at 5 years (26) and/or 8 years (27). Brain imaging scores corrected for gestational age at scan time were correlated with outcome measures, adjusting for known clinical confounders.ResultsClinically significant findings were identified on MRI of 16 (28%) infants. Mean scores were in the normal range for all domains assessed at each age. Language impairment was seen in 23% at 2 years and verbal intellectual impairment in 25% at 8 years. Mean cognitive scores were lower in 2-year-old children with white matter injury on MRI (p=0.03). Mean motor scores were lower in 2-year-old children with brain immaturity (p=0.01). Associations between MRI and 5-year and 8-year assessments were no longer significant when adjusting for known clinical confounders.ConclusionsNeuroimaging abnormalities were associated with worse neurodevelopment at 2 years, but not with later neurocognitive outcomes, after accounting for clinical risk factors.

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One-year outcomes of congenital diaphragmatic hernia repair: Factors associated with recurrence and complications

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2020.09.018 ◽

2020 ◽

Author(s):

Alessia C. Cioci ◽

Eva M. Urrechaga ◽

Joshua Parreco ◽

Lindsay F. Remer ◽

Maiya Cowan ◽

...

Keyword(s):

Hernia Repair ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Factors Associated ◽

One Year ◽

Diaphragmatic Hernia Repair

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Outcome of Congenital Diaphragmatic Hernia: A Single Center Experience

Journal of Neonatal Surgery ◽

10.47338/jns.v8.354 ◽

2020 ◽

Vol 8 (4) ◽

pp. 29

Author(s):

Jayasree Chandramati ◽

Lakshmi S Nair ◽

Smriti M Menon ◽

Ashwin Prabhu ◽

Mohan Abraham ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Retrospective Cohort ◽

Prognostic Markers ◽

Fetal Lung ◽

Left Ventricular ◽

Management Guidelines ◽

Factors Associated ◽

Remarkable Improvement ◽

Single Center Experience

Background: Congenital diaphragmatic hernia (CDH) is a complex malformation with a challenging perioperative care. The outcome is still not very impressive in developing countries despite its remarkable improvement in developed countries.Methods: We analyzed outcomes, and factors associated with morbidity and mortality of 120 newborns with CDH, managed at our institution.Results: The overall survival was 73.4%. Chromosomal aberrations, pneumothorax within 24 hours, left ventricular hypoplasia, biventricular dysfunction, fetal lung to head ratio (LHR)Conclusion: This is the largest series of a retrospective cohort study of CDH reported in India. We have briefly reviewed the topic and the management guidelines along with prognostic markers derived from this study.

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Predicting Full Enteral Feeding in the Postoperative Period in Infants with Congenital Diaphragmatic Hernia

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1597655 ◽

2017 ◽

Vol 27 (05) ◽

pp. 431-436 ◽

Cited By ~ 11

Author(s):

Miryam Triana ◽

Rosario Madero ◽

Steven Abrams ◽

Leopoldo Martinez ◽

Maria Amesty ◽

...

Keyword(s):

Gastroesophageal Reflux ◽

Congenital Diaphragmatic Hernia ◽

Hospital Discharge ◽

Diaphragmatic Hernia ◽

Enteral Feeding ◽

Postoperative Period ◽

Surgical Repair ◽

Factors Associated ◽

Enteral Feedings ◽

Full Enteral Feeding

Introduction The objective of the study is to examine the factors associated with time to achieve full enteral feeding after repair of congenital diaphragmatic hernia. Materials and Methods Demographic, clinical, and therapeutic data were retrospectively assessed, and uni- and multivariate Cox regression were performed to examine factors predictive of achieving full enteral feeding that was defined as time to achieve120 mL/kg/d after surgical repair. Results Of 78 infants, 66 underwent intervention before hospital discharge. All infants who survived had reached full enteral feeding at the time of hospital discharge by a median of 22 days (range: 2–119 days) after surgery and 10 days (range: 1–91) after initiation of postoperative enteral feedings. Independent risk factors associated with a longer time to reach full enteral feeding achievement included gastroesophageal reflux and days of antibiotics in the postoperative period. Daily stool passage preoperatively predicted earlier enteral tolerance. Conclusion Infants who survive congenital diaphragmatic hernia generally are able to achieve full enteral feedings after surgical repair. A longer time to full feeding is needed in the most severe cases, but some specific characteristics can be used to help identify patients at higher risk. Although some of these characteristics are unavoidable, others including rational antibiotic usage and active gastroesophageal reflux prevention and treatment are feasible and may improve enteral tolerance.

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Early population-based outcomes of infants born with congenital diaphragmatic hernia

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313933 ◽

2018 ◽

Vol 103 (6) ◽

pp. F517-F522 ◽

Cited By ~ 13

Author(s):

Anna-May Long ◽

Kathryn J Bunch ◽

Marian Knight ◽

Jennifer J Kurinczuk ◽

Paul D Losty

Keyword(s):

Prognostic Factors ◽

Prenatal Diagnosis ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Population Based ◽

International Studies ◽

Factors Associated ◽

Female Sex ◽

Pulmonary Vasodilators ◽

The Uk

PurposeThis study aims to describe short-term outcomes of live-born infants with congenital diaphragmatic hernia (CDH) and to identify prognostic factors associated with early mortality.DesignA prospective population cohort study was undertaken between April 2009 and September 2010, collecting data on live-born infants with CDH from all 28 paediatric surgical centres in the UK and Ireland using an established surgical surveillance system. Management and outcomes are described. Prognostic factors associated with death before surgery are explored.ResultsTwo hundred and nineteen live-born infants with CDH were reported within the data collection period. There were 1.5 times more boys than girls (n=133, 61%). Thirty-five infants (16%) died without an operation. This adverse outcome was associated with female sex (adjusted OR (aOR) 3.96, 95% CI 1.66 to 9.47), prenatal diagnosis (aOR 4.99, 95% CI 1.31 to 18.98), and the need for physiological support in the form of inotropes (aOR 9.96, 95% CI 1.19 to 83.25) or pulmonary vasodilators (aOR 4.09, 95% CI 1.53 to 10.93). Significant variation in practice existed among centres, and some therapies potentially detrimental to infant outcomes were used, including pulmonary surfactant in 45 antenatally diagnosed infants (34%). Utilisation of extracorporeal membrane oxygenation was very low compared with published international studies (n=9/219, 4%). Postoperative 30-day survival was 98% for 182 infants with CDH who were adequately physiologically stabilised and underwent surgery.ConclusionThis is the first British Isles population-based study reporting outcome metrics for infants born with CDH. 16% of babies did not survive to undergo surgery. Factors associated with poor outcome included female sex and prenatal diagnosis. Early postoperative survival in those who underwent surgical repair was excellent.

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