Long term follow-up in high-risk congenital diaphragmatic hernia survivors: patching the diaphragm affects the outcome.
OBJECTIVE
The increased survival rate reached in infants with congenital diaphragmatic hernia (CDH) has shown a concomitant increase in late morbidity. A recent report from CDH Study Group showed that dimension of diaphragmatic defect is the only independent risk factor of mortality. However, the influence of defect size on late morbidity is still controversial. The aim of the study was to evaluate the influence of patch repair (proxy of diaphragmatic defects size) on midterm morbidity.


METHODS
All high-risk (prenatal diagnosis and/or respiratory symptoms within 6 hours of life) CDH survivors treated at our institution from 2004 to 2008 were followed up in a multidisciplinary outpatient clinic as part of a longitudinal prospective study. Auxological, gastroesophageal, pulmonary, and orthopedic evaluations were performed at 6, 12, and 24 months of age. Patient outcomes were compared with respect to +/- patch repair.


RESULTS
Of 70 survivors, 61 (87%) were enrolled and prospectively evaluated in follow-up. Poorer auxological outcome, increased rate of gastroesophageal reflux, and altered pulmonary function test were observed during follow-up.


CONCLUSIONS
Patch repair correlates with higher pulmonary, auxological, and gastroesophageal morbidity without increasing chest wall deformities at long-term follow-up.
Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Research Hospital, 00165 Rome, Italy. laura.valfre@opbg.net
Laura
L
Valfrè
Annabella
A
Braguglia
Andrea
A
Conforti
Francesco
F
Morini
Alessandro
A
Trucchi
Barbara Daniela
BD
Iacobelli
Antonella
A
Nahom
Natalia
N
Chukhlantseva
Andrea
A
Dotta
Carlo
C
Corchia
Pietro
P
Bagolan
D002675:Child, Preschool; D003964:Diaphragm / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000473:pathology / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D035441:Thoracic Wall / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome