Growth trajectory and neurodevelopmental outcome in infants with congenital diaphragmatic hernia

Antiel, Ryan M.; Lin, Nan; Licht, Daniel J.; Hoffman, Casey; Waqar, Lindsay N.; Xiao, Rui; Monos, Stylianos; D’Agostino, Jo Ann; Bernbaum, Judy; Herkert, Lisa M.; Rintoul, Natalie E.; Peranteau, William H.; Flake, Alan W.; Adzick, N. Scott; Hedrick, Holly L.

doi:10.1016/j.jpedsurg.2017.08.063

Cited by 29 publications

(22 citation statements)

References 38 publications

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“…Despite this, some infants were reported by collaborating centres to have developmental impairment(s) and/or seizure activity. Future well-designed studies incorporating large patient numbers in registries/networks may uncover the true incidence of neurological and developmental sequelae including neurosensory impairment, epilepsy and autism 25–29. Parent groups, supported by medical professionals have long called for a national registry of infants with CHD to prospectively collect data on infant characteristics and outcomes (CDH UK Parent Group – Personal Communication, 2018).…”

Section: Discussionmentioning

confidence: 99%

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

Long

Bunch

Knight

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo report outcomes to 1 year, in infants born with congenital diaphragmatic hernia (CDH), explore factors associated with infant mortality and examine the relationship between surgical techniques and postoperative morbidity.DesignProspective national population cohort study.SettingPaediatric surgical centres in the UK and Ireland.MethodData were collected to 1 year for infants with CDH live-born between 1 April 2009 to 30 September 2010. Factors associated with infant mortality are explored using logistic regression. Postoperative morbidity following patch versus primary closure, minimally invasive versus open surgery and biological versus synthetic patch material is described. Data are presented as n (%) and median (IQR).ResultsOverall known survival to 1 year was 75%, 95% CI 68% to 81% (138/184) and postoperative survival 93%, 95% CI 88% to 97% (138/148). Female sex, antenatal diagnosis, use of vasodilators or inotropes, being small for gestational age, patch repair and use of surfactant were all associated with infant death. Infants undergoing patch repair had a high incidence of postoperative chylothorax (11/54 vs 2/96 in infants undergoing primary closure) and a long length of hospital stay (41 days, IQR 24–68 vs 16 days, IQR 10–25 in primary closure group). Infants managed with synthetic patch material had a high incidence of chylothorax (11/34 vs 0/19 with biological patch).ConclusionThe majority of infant deaths in babies born with CDH occur before surgical correction. Female sex, being born small for gestational age, surfactant use, patch repair and receipt of cardiovascular support were associated with a higher risk of death. The optimum surgical approach, timing of operation and choice of patch material to achieve lowest morbidity warrants further evaluation.

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Section: Discussionmentioning

confidence: 99%

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

Long

Bunch

Knight

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…While simple, easily identifiable traits are unarguably a core and important aspect of growth monitoring, a better understanding of the different patterns of early childhood weight gain that may exist in a population is needed and would be informative for those interested in monitoring the growth of children. Numerous papers have summarised early childhood weight trajectories in terms of individual‐level traits, 5,9‐11 but we are only aware of seven publications that have analysed early childhood weight data using growth mixture modelling, 18‐24 an advanced technique that identifies distinct latent classes of individuals who share similar trajectories 25 . None of these publications included a normal, healthy sample in a high‐income country with body composition outcomes.…”

Section: Introductionmentioning

confidence: 99%

Early childhood weight gain: Latent patterns and body composition outcomes

Norris

Mansukoski

Gilthorpe

et al. 2021

Paediatric Perinatal Epid

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Background Despite early childhood weight gain being a key indicator of obesity risk, we do not have a good understanding of the different patterns that exist. Objectives To identify and characterise distinct groups of children displaying similar early‐life weight trajectories. Methods A growth mixture model captured heterogeneity in weight trajectories between 0 and 60 months in 1390 children in the Avon Longitudinal Study of Parents and Children. Differences between the classes in characteristics and body size/composition at 9 years were investigated. Results The best model had five classes. The “Normal” (45%) and “Normal after initial catch‐down” (24%) classes were close to the 50th centile of a growth standard between 24 and 60 months. The “High‐decreasing” (21%) and “Stable‐high” (7%) classes peaked at the ~91st centile at 12‐18 months, but while the former declined to the ~75th centile and comprised constitutionally big children, the latter did not. The “Rapidly increasing” (3%) class gained weight from below the 50th centile at 4 months to above the 91st centile at 60 months. By 9 years, their mean body mass index (BMI) placed them at the 98th centile. This class was characterised by the highest maternal BMI; highest parity; highest levels of gestational hypertension and diabetes; and the lowest socio‐economic position. At 9 years, the “Rapidly increasing” class was estimated to have 68.2% (95% confidence interval [CI] 48.3, 88.1) more fat mass than the “Normal” class, but only 14.0% (95% CI 9.1, 18.9) more lean mass. Conclusions Criteria used in growth monitoring practice are unlikely to consistently distinguish between the different patterns of weight gain reported here.

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“…Early brain development alteration might occur long before neurological symptoms and consequently they could represent a first marker for future neurodevelopmental impairments [43]. In patients with CDH, MRI findings of postnatal brain injury were associated with motor dysfunction [15], lower cognitive scores and language deficits [9,10,12], but no correlation resulted between neurological outcome and prenatal MRI findings [14]. These findings were further confirmed for long-term outcomes, resulting in impaired language and visual motor skills, behavioral, cognitive, developmental delay and hearing loss.…”

Section: Discussionmentioning

confidence: 99%

“…Among these, long-term neurological sequelae raise particular concern [3], although studies describing the neurological outcome of CDH survivors who are not treated with neonatal ECMO are limited [4]. Earlier studies report long-term outcomes, with evidence of impaired language and visual motor skills, behavioral, cognitive and developmental delay and hearing loss [5][6][7][8][9][10]. This evidence was further confirmed for short-term evaluation, where neurodevelopmental assessment at one year of age revealed mild (44%) and severe (13%) delay in at least one domain among cognitive, language and motor functions, depending on several determinants such as intubation, oxygen requirement and intensive care unit stay [4,11].…”

Section: Introductionmentioning

confidence: 99%

Morphometric Analysis of Brain in Newborn with Congenital Diaphragmatic Hernia

et al. 2021

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Congenital diaphragmatic hernia (CDH) is a severe pediatric disorder with herniation of abdominal viscera into the thoracic cavity. Since neurodevelopmental impairment constitutes a common outcome, we performed morphometric magnetic resonance imaging (MRI) analysis on CDH infants to investigate cortical parameters such as cortical thickness (CT) and local gyrification index (LGI). By assessing CT and LGI distributions and their correlations with variables which might have an impact on oxygen delivery (total lung volume, TLV), we aimed to detect how altered perfusion affects cortical development in CDH. A group of CDH patients received both prenatal (i.e., fetal stage) and postnatal MRI. From postnatal high-resolution T2-weighted images, mean CT and LGI distributions of 16 CDH were computed and statistically compared to those of 13 controls. Moreover, TLV measures obtained from fetal MRI were further correlated to LGI. Compared to controls, CDH infants exhibited areas of hypogiria within bilateral fronto-temporo-parietal labels, while no differences were found for CT. LGI significantly correlated with TLV within bilateral temporal lobes and left frontal lobe, involving language- and auditory-related brain areas. Although the causes of neurodevelopmental impairment in CDH are still unclear, our results may suggest their link with altered cortical maturation and possible impaired oxygen perfusion.

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Growth trajectory and neurodevelopmental outcome in infants with congenital diaphragmatic hernia

Cited by 29 publications

References 38 publications

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

Early childhood weight gain: Latent patterns and body composition outcomes

Morphometric Analysis of Brain in Newborn with Congenital Diaphragmatic Hernia

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