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Lung function in school‐aged congenital diaphragmatic hernia patients; a longitudinal evaluation
Author(s) -
ToussaintDuyster Leontien C. C.,
Cammenvan Zijp Monique H. M.,
Spoel Marjolein,
Tiddens Harm A. W. M.,
Tibboel Dick,
Wijnen Rene M. H.,
Rosmalen Joost,
IJsselstijn Hanneke
Publication year - 2019
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.24375
Subject(s) - medicine , congenital diaphragmatic hernia , extracorporeal membrane oxygenation , confidence interval , ventilation (architecture) , pulmonary function testing , lung , lung volumes , mechanical ventilation , diaphragmatic breathing , anesthesia , cardiology , surgery , pathology , pregnancy , mechanical engineering , fetus , genetics , alternative medicine , engineering , biology
Objective Children with congenital diaphragmatic hernia (CDH) are at risk for pulmonary morbidity. Data on longitudinal evaluation of lung function in CDH are scarce. We hypothesized that CDH patients would have impaired lung function that worsens over time. We evaluated lung function and its determinants at ages 8 and 12 years. Methods Dynamic and static lung volumes, and diffusion capacity were measured. Extracorporeal membrane oxygenation (ECMO) treatment, the standardized European neonatal treatment protocol, patch repair, duration of ventilation, type of initial mechanical ventilation, and nitric oxide treatment were entered as covariates in linear mixed models with standard deviation score (SDS) lung function parameters (FEV 1 , FEF 25‐75 , and K CO ) as dependent variables. Results Seventy‐six children (27 ECMO‐treated) born between 1999 and 2009 performed 113 reliable lung function tests. Severity of airflow obstruction deteriorated significantly from age 8 to 12 years: estimated mean difference (95% confidence interval [CI]) SDS FEV 1 was −0.57 (−0.79 to −0.36) and SDS FEF 25‐75 was −0.63 (−0.89 to −0.37), both P < .001. Static lung volumes were within normal range and unchanged over time: estimated mean difference (95% CI) SDS TLC −0.27 (−0.58 to 0.04); P = .085. SDS K CO was below normal at 8 and 12 years and remained stable: −0.06 (−0.22 to 0.35); P = .648. These observations were irrespective of ECMO treatment. FEV 1 and FEF 25‐75 were negatively associated with duration of ventilation ( P < .001). Baseline data were not related with TLC or K CO.Conclusions CDH patients should be followed into adulthood as they are at risk for worsening airflow obstruction and decreased diffusion capacity at school age, irrespective of ECMO treatment.