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Long‐term pulmonary morbidity in survivors of congenital diaphragmatic hernia
Author(s) -
Trachsel Daniel,
Selvadurai Hiran,
Bohn Desmond,
Langer Jacob C.,
Coates Allan L.
Publication year - 2005
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20193
Subject(s) - medicine , pulmonary function testing , perioperative , congenital diaphragmatic hernia , cohort , airway obstruction , asthma , lung volumes , anesthesia , surgery , pediatrics , airway , lung , pregnancy , fetus , biology , genetics
Our objective was to study long‐term respiratory outcomes of congenital diaphragmatic hernia (CDH) treated in the perinatal period. This was a cohort study with 26 adolescent survivors and age‐ and gender‐matched controls. Medical histories were retrieved from hospital charts and questionnaires. Pulmonary function testing included measurement of maximum inspiratory and expiratory pressures (MIPS and MEPS) and maximum voluntary ventilation (MVV). Unpaired two‐tailed t ‐test and nonlinear regression were used for statistical analysis. Significant differences were found in forced expiratory volume in one second (FEV 1 ) (79% ± 16% vs. 94% ± 10%, P < 0.001), FEF 25–75 (62% ± 24% vs. 84% ± 15%, P < 0.001), FRC (114% ± 20% vs. 95% ± 13%, P < 0.001), RV/TLC (31% ± 10% vs. 22% ± 6%, P < 0.001), MVV (74% ± 16% vs. 90% ± 13%, P < 0.001), and MIPS (69% ± 19% vs. 84% ± 16%, P < 0.01), with numbers indicating percent predicted of reference values ± SD. Reduction of MVV was not independent from FEV 1 (r = 0.83). Forty‐eight percent of patients vs. 4% of controls showed significant improvement of FEV 1 after bronchodilators (86% ± 15 vs. 98% ± 10, P < 0.01). Forty‐six percent of patients had abnormalities of the chest wall or spinal column such as pectus excavatum, pectus carinatum, and scoliosis, mostly mild or moderate. In conclusion, long‐term respiratory outcome in adolescent CDH is associated with mild to moderate airway obstruction, a high prevalence of response to bronchodilators, and decreased inspiratory muscle strength. This should guide follow‐up scheduling and should be taken into account for perioperative and critical care management. © 2005 Wiley‐Liss, Inc.