title: Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors.
abstract: OBJECTIVE
  Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors.
  
  
  METHODS
  Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7years) was defined as a score<80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher's exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables.
  
  
  RESULTS
  Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9years. Seven (44%) of the children evaluated had NCD. Patch repair (p=0.01), extracorporeal membrane oxygenation (ECMO; p=0.02), days on ECMO (p=0.01), days of mechanical ventilation (p=0.049), and post-operative use of inhaled nitric oxide (p=0.02) were found to be associated with NCD at early school age.
  
  
  CONCLUSIONS
  CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood.
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, MA 02118, USA. jbenjamin@tuftsmedicalcenter.org
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Benjamin
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Gustafson
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Ellingsen
authors.forename: K Brooke
authors.initials: KB
authors.lastname: Tompkins
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.forename: Ricki F
authors.initials: RF
authors.lastname: Goldstein
mesh_terms: D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D016015:Logistic Models; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017741:Survivors
chemical_list: D009569:Nitric Oxide