Document Detail


Prospective longitudinal evaluation of lung function during the first year of life after repair of congenital diaphragmatic hernia.
MedLine Citation:
PMID:  21666527     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: To evaluate lung function and respiratory morbidity prospectively during the first year of life in patients with congenital diaphragmatic hernia and to study the effect of extracorporeal membrane oxygenation therapy. DESIGN:: Prospective longitudinal cohort study. SETTING:: Outpatient clinic of a tertiary-level pediatric hospital. PATIENTS:: The cohort of 43 infants included 12 patients treated with extracorporeal membrane oxygenation. Evaluation was at 6 and 12 months; 33 infants were evaluated at both time points. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Maximal expiratory flow at functional residual capacity and functional residual capacity were measured with Masterscreen Babybody. Z-scores were calculated for maximal expiratory flow at functional residual capacity. Mean maximal expiratory flow at functional residual capacity values at 6 and 12 months were significantly below the expected values (mean z-score -1.4 and -1.5, respectively) without a significant change between both time points. Values did not significantly differ between extracorporeal membrane oxygenation and nonextracorporeal membrane oxygenation-treated patients. Functional residual capacity values were generally high, 47% were above the suggested normal range, and did not change significantly over time. Mean functional residual capacity values in patients on extracorporeal membrane oxygenation were significantly higher than in nonextracorporeal membrane oxygenation patients (p = .006). The difference (5.1 mL/kg ± 1.8 se) did not change significantly between the two time points. Higher mean airway pressure and longer duration of ventilation were associated with higher functional residual capacity. None of the perinatal characteristics was associated with maximal expiratory flow at functional residual capacity. Mean weight z-scores were significantly below zero at both time points (p < .001). Mean weight z-score in patients on extracorporeal membrane oxygenation were lower than in nonextracorporeal membrane oxygenation patients (p = .046). CONCLUSIONS:: Infants with congenital diaphragmatic hernia have decreased expiratory flows and increased functional residual capacity within the first year of life. Extracorporeal membrane oxygenation-treated patients with congenital diaphragmatic hernia may have more respiratory morbidity and concomitant growth impairment. Close follow-up beyond the neonatal period is therefore required.
Authors:
Marjolein Spoel; Lieke van den Hout; Saskia J Gischler; Wim C J Hop; Irwin Reiss; Dick Tibboel; Johan C de Jongste; Hanneke Ijsselstijn
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-9
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  -     ISSN:  1529-7535     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Intensive Care and Department of Pediatric Surgery (MS, LvdH, SJG, IR, DT, HI), the Department of Pediatrics (JCdJ), Division of Pediatric Respiratory Medicine, and the Department of Biostatistics (WCJH), Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands.
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