PHOENIX — Children with congenital diaphragmatic hernia are likely to have long-term health problems requiring close, long-term follow-up, Dr. Tim Jancelewicz said at the annual meeting of the American Pediatric Surgical Association.
Dr. Jancelewicz, of the University of California, San Francisco, and his colleagues reviewed 357 clinic visits made over a 10-year period by 90 patients with congenital diaphragmatic hernia (median follow-up 4 years). Of those, 8% required extracorporeal membrane oxygenation (median 15 days). Initial patch repair was done in 57%, and 36% have had recurrence of the hernias.
The children underwent neurodevelopmental assessment, which identified normal neurodevelopmental outcomes in 55% of the cohort. Another 13% had suspect disease, 24% had confirmed abnormal outcomes, findings for 8% were undetermined.
Four factors significantly predicted neurodevelopmental delay: liver herniation at birth, initial patch repair, intubation for at least 15 days, and discharge home on oxygen. Neurodevelopmental delay was seen in 59% of those with liver herniation, 60% of those with initial patch repair, 67% of those with at least 15 days of intubation, and 82% of those who were discharged on oxygen.
All of the children had hearing assessments; only 46% had normal hearing. Two factors, initial patch repair and intubation of at least 15 days, significantly predicted hearing loss. Of those with an initial patch repair, 43% had hearing loss. None of those who had a primary repair had hearing loss. While 44% of those with more than 15 days of intubation developed hearing loss, 95% of those with less than 15 days of intubation had normal hearing.