title: Predicting inadequate long-term lung development in children with congenital diaphragmatic hernia: an analysis of longitudinal changes in ventilation and perfusion.
abstract: OBJECTIVE
  Infants born with congenital diaphragmatic hernia (CDH) demonstrate a wide variability in postnatal catch-up lung growth. The goals of this study were to assess the pulmonary development of children born with CDH using sequential ventilation-perfusion (V/Q) scintigraphy and to identify the perinatal factors that correspond to a progressive V/Q mismatch.
  
  
  METHODS
  The records of 137 patients seen between 1990 and 2005 in a multidisciplinary CDH clinic were reviewed. Changes in the ipsilateral V/Q quotient were compared in 46 patients who had 2 or more studies with the following variables: sex, patch repair, laterality, gestational age, and use of extracorporeal membrane oxygenation. An abnormal V/Q quotient was defined as greater than 1.2 (reference range, 0.8-1.2).
  
  
  RESULTS
  Abnormal V/Q scans were identified in 28 (61%) of the 46 patients at the time of the last V/Q study. Patients who underwent a patch repair had nearly 7 times the risk (P < .001) of developing an ipsilateral V/Q mismatch. The use of extracorporeal membrane oxygenation had a variable effect on the probability of an abnormal V/Q study finding. No other variable was significant.
  
  
  CONCLUSIONS
  Many children with CDH develop significant and progressive V/Q mismatches. Although some perinatal variables appear to be predictive of this phenomenon, they may simply be surrogates for a greater degree of pulmonary hypoplasia present at birth. This subpopulation of CDH survivors is an identifiable group clearly at risk and thus requires long-term follow-up.
authors.affiliation: Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Hayward
authors.forename: Virginia
authors.initials: V
authors.lastname: Kharasch
authors.forename: Catherine
authors.initials: C
authors.lastname: Sheils
authors.forename: Sandra
authors.initials: S
authors.lastname: Friedman
authors.forename: Mary-Jo
authors.initials: MJ
authors.lastname: Dunleavy
authors.forename: Sherri
authors.initials: S
authors.lastname: Utter
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Russell
authors.initials: R
authors.lastname: Jennings
authors.forename: Jay M
authors.initials: JM
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008168:Lung / Q000098:blood supply* / Q000254:growth & development* / Q000503:physiopathology; D008297:Male; D009929:Organ Size; D012123:Pulmonary Ventilation; D011877:Radionuclide Imaging; D012189:Retrospective Studies