Article Text

CLINICAL CORRELATION AND PULMONARY FUNCTION AT SIX YEARS OF AGE AFTER CONGENITAL DIAPHRAGMATIC HERNIA REPAIR
  1. J Tautz1,
  2. M Detzel1,
  3. M Kratz1,
  4. S Demirakca1,
  5. T Schaible1
  1. 1University Clinic, Mannheim Children’s Hospital, Mannheim, Germany

Abstract

Objectives The aim of this study was to determine the pulmonary sequelae of patients with congenital diaphragmatic hernia (CDH).

Study Design This was a prospective study of our ECMO centre at the university children hospital of Mannheim, Germany. 26 survivors after CDH repair completed pulmonary function testing at 6 years of age. 14 (54%) received extracorporeal membrane oxygenation (ECMO). Pulmonary outcome was based on spirometry and lung volume data. Pulmonary outcome for each treatment group is reported as mean and as percent predicted. Individually subjects were also classified based on spirometry, as either normal, obstructed (defined as forced expiratory volume (FEV(1)) in 1 sec:forced vital capacity (FVC) of <80% predicted, or with reduced FVC (FCV of <80% predicted) with normal FEV(1)/FVC. Risk for adverse outcome was determined using univariate analysis. Additionally the effect of bronchospasmolysis was evaluated.

Results Mean FVC, FEV(1) and FEV(25–75) were reduced in the total cohort. The reduction was greater in the group with ECMO. Assessed individually, 27% of subjects had normal spirometry and lung volumes, 65% airflow obstruction, and 77% reduced FVC. Poorer pulmonary outcome was linked to ECMO and need for prolonged supplemental oxygen. Bronchospasmolysis by beta-2-sympathomimetic drugs is able to improve FEV (25–75) significantly regarding the whole cohort.

Conclusion Neonates with CDH and needing ECMO are at increased risk of poorer pulmonary outcome and require close follow-up. Testing bronchospasmolysis may identify patients for targeted treatment.

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