title: Risk of Readmission for Wheezing during Infancy in Children with Congenital Diaphragmatic Hernia.
abstract: Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization during infancy, although actual frequency of readmissions is unknown.
  
  
  
  We aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission.
  
  
  
  Data about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database.
  
  
  
  Ninety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctor's visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization.
  
  
  
  The rate of readmission for wheezing among infants with CDH is high, and significantly influenced by several prenatal and neonatal factors. Palivizumab prophylaxis was not associated with the rate of readmission.
authors.affiliation: Pneumologie Pédiatrique, Necker, AP-HP, Paris, France, Centre de Référence des Maladies Respiratoires Rares, Paris, France.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Benoist
authors.affiliation: Réanimation pédiatrique, AP-HP, Bicêtre, France.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Mokhtari
authors.affiliation: Pneumologie Pédiatrique, CHRU, Lille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Deschildre
authors.affiliation: Chirurgie Pédiatrique, Necker, AP-HP, Paris, France.|Université Paris-Descartes, Paris, France.
authors.forename: Naziha
authors.initials: N
authors.lastname: Khen-Dunlop
authors.affiliation: Pneumologie Pédiatrique, CHRU, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Storme
authors.affiliation: Gynécologie Obstétrique, Antoine Béclère, AP-HP, Paris, France, Centre de Référence des Hernies Diaphragmatiques, Clamart, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
authors.affiliation: Pneumologie Pédiatrique, Necker, AP-HP, Paris, France, Centre de Référence des Maladies Respiratoires Rares, Paris, France.|Université Paris-Descartes, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Delacourt
mesh_terms: D002648:Child; D065630:Hernias, Diaphragmatic, Congenital / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012135:Respiratory Sounds / Q000503:physiopathology*; D012307:Risk Factors