Lung volumes and distribution of ventilation in survivors to congenital diaphragmatic hernia (CDH) during infancy.
The assessment of lung volumes, particularly functional residual capacity (FRC), is crucial for understanding lung development during infancy in CDH patients.


OBJECTIVE
To evaluate changes in lung function during infancy in subjects with CDH treated with a "gentle ventilation" technique and delayed surgery strategy in the neonatal period.


METHODS
13 CDH infants were studied twice and compared with a population of 28 healthy infants (HI). Tidal-Volume (Vt), respiratory rate (RR) and time to peak expiratory flow/expiratory time ratio (tPTEF/Te) were measured with an ultrasonic flow meter; Compliance (Crs) and Resistance (Rrs) of the respiratory system were studied with the single occlusion technique; FRC and Lung Clearance Index (LCI), were assessed with the sulfur hexafluoride (SF6) wash-in/wash-out technique. The differences between the first (T1) and second (T2) measurement in the CDH group were assessed by the Student's t-test for paired values. For each set of measurement (T1 and T2) the values were compared with HI by Student's t-test.


RESULTS
Mean age at test was 7.5 +/- 5.2 months for HI, 4.5 +/- 2.5 at T1 and 11.9 +/- 4.5 months at T2 for CDH infants. At T1 there were no significant differences between CDH infants and HI in Vt, Crs, and FRC, while tPTEF/te ratio was lower and RR, Rrs, and LCI were higher in CDH patients than in HI. At T2 Vt, Crs, and FRC remained normal in CDH patients as well as RR that, at this time was not different between CDH and healthy infants; tPTEF/te remained below and Rrs and LCI remained above normal ranges, indicating a persistent impairment in lower airways patency.


CONCLUSIONS
Lung function in infants with severe CDH is characterized by a persistent impairment in airways patency and significant inhomogeneity of ventilation, suggesting a peripheral bronchial obstruction even if the other lung function tests are within normal ranges.
Dotta
Andrea
A
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy. dotta@opbg.net
Palamides
Sabrina
S
Braguglia
Annabella
A
Crescenzi
Francesco
F
Ronchetti
Maria Paola
MP
Calzolari
Flaminia
F
Iacobelli
Barbara Daniela
BD
Bagolan
Pietro
P
Corchia
Carlo
C
Orzalesi
Marcello
M
D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000503:physiopathology* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000254:growth & development*; D008176:Lung Volume Measurements; D008297:Male; D009929:Organ Size; D017741:Survivors