title: Neurodevelopmental outcome at one year of age in congenital diaphragmatic hernia infants not treated with extracorporeal membrane oxygenation.
abstract: BACKGROUND
  We evaluated the neurodevelopmental (ND) outcome at one year of age for congenital diaphragmatic hernia (CDH) children who have not undergone extracorporeal membrane oxygenation (ECMO) treatment during the neonatal period.
  
  
  METHODS
  Between 01/2005 and 06/2012, 63 consecutive CDH patients underwent ND assessment using the BSID-III at a median age of 12 months. ND delay was defined by a score of ≤ 85 in any of the composite scales. Severe impairment was defined as a score of ≤ 69 in at least one domain.
  
  
  RESULTS
  Mean ± SD cognitive, language, and motor functions were 94 ± 14, 86 ± 14, 90 ± 15, respectively (normal 100 ± 15, P<0.01 for each). Forty-three-percent scored within the average range for all scales. Forty-four-percent had mild, and 13% had severe delays in at least one domain. Prolonged NICU stay, intubation and O2 requirement, fundoplication, abnormal BAERs, and tracheostomy were associated with lower scores in all domains. Right-sided CDH, male gender, lower 5 min APGAR, pulmonary hypertension, and delayed start of enteral feeding were predictive of lower cognitive and/or language scores.
  
  
  CONCLUSIONS
  At one year of age, a high percentage of CDH children whose illness did not necessitate ECMO have below normal ND scores. Modifiable and non-modifiable factors are significant determinants of adverse outcomes.
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA. Electronic address: danzere@email.chop.edu.
authors.forename: Enrico
authors.initials: E
authors.lastname: Danzer
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Marsha
authors.initials: M
authors.lastname: Gerdes
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: D'Agostino
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Bernbaum
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Hoffman
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Herkert
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Rintoul
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
mesh_terms: D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Bayley Scales of Infant Development; Congenital diaphragmatic hernia; ECMO; Hypotonicity; Neurodevelopmental outcome; Pulmonary hypoplasia