Longitudinal evaluation of diaphragmatic function in children with congenital diaphragmatic hernia

Abstract

Background: Congenital diaphragmatic hernia (CDH) is a rare malformation, causing respiratory distress in newborns, and requiring surgical treatment. Few studies have evaluated diaphragmatic function, but none has performed a longitudinal evaluation. Aims and objectives: To assess the respiratory function in CDH children at different post-surgery periods, with emphasis on diaphragmatic function. Methods: Breathing pattern and respiratory muscle strength were measured by means of esophageal (Pes) and gastric (Pgas) pressures. Results: Twenty-eight patients with antenatal or birth day CDH diagnosis (24 left, 4 right) were included. A diaphragmatic patch was necessary in 6 patients. Twelve patients were assessed prior to NICU discharge (N), 6 about 1-2 years after surgery (S1), and 10 about 5-6 years after surgery (S5). Mean antenatal estimated pulmonary volume (VLA) was 41±10%pr. Gastric pressure during sniff (SniffPgas) was negative at N (-58±22 cmH2O) and S1 (-53±36 cmH2O), reflecting diaphragmatic dysfunction, and improved significantly at S5 (+3±9 cmH2O; p Conclusions: Diaphragmatic dysfunction is present at neonatal period in CDH and improves slowly with age. VLA is predictive of diaphragmatic capacity in the neonatal period.