Predictors of gastroesophageal reflux in neonates with congenital diaphragmatic hernia.
OBJECTIVE
Gastroesophageal reflux (GER) is observed in 22% to 81% of neonates with congenital diaphragmatic hernia (CDH). The purpose of this study was to identify factors that may predict GER requiring fundoplication in neonates with CDH.


METHODS
A retrospective chart review was performed on all neonates with CDH treated at our hospital from June 1997 to June 2005. Preoperative respiratory status, side of the CDH, and method of repair were assessed as predictors of GER and the need for fundoplication.


RESULTS
Of the 42 patients with CDH, 3 died before intervention, leaving 39 patients eligible for study. All but 1 patient survived until discharge. Twenty-one (54%) developed GER of whom 9 (23%) required fundoplication. Although the side of the CDH was not a determinant of GER or the need for fundoplication, patch repair and the need for extracorporeal life support were determinants of both.


CONCLUSIONS
Gastroesophageal reflux is common among babies with CDH, although symptoms often resolve without surgical intervention. Infants with CDH defects requiring a patch repair and those requiring advanced physiologic support, especially extracorporeal life support, are likely to develop severe GER necessitating fundoplication. Early recognition and treatment of GER among high-risk patients may shorten hospital stay and minimize patient morbidity. Early fundoplication should be considered for those patients at the highest risk.
Su
Wendy
W
Department of Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada H3H1P3.
Berry
Margaret
M
Puligandla
Pramod S
PS
Aspirot
Ann
A
Flageole
Hélène
H
Laberge
Jean-Martin
JM
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005774:Gastrostomy / Q000706:statistics & numerical data; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008020:Life Support Care / Q000706:statistics & numerical data; D008168:Lung / Q000002:abnormalities; D008297:Male; D012120:Respiration Disorders / Q000209:etiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013270:Stomach / Q000002:abnormalities; D013526:Surgical Mesh
D000897:Anti-Ulcer Agents