Impaired somatic growth and delayed lung development in infants with congenital diaphragmatic hernia—evidence from a 10-year, single center prospective follow-up study

Roehr, Charles Christoph; Proquitté, Hans; Jung, Andreas; Ackert, Ulrike; Bamberg, Christian; Degenhardt, P.; Hammer, Hannes; Wauer, Roland R.; Schmalisch, Gerd

doi:10.1016/j.jpedsurg.2008.10.047

Cited by 23 publications

(21 citation statements)

References 27 publications

(39 reference statements)

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“…The observed faster increase in FRC compared with Cresp in CDH infants agrees with a recent study by ROEHR et al [20] showing that despite apparently well-inflated lungs, CDH patients had worse tidal breathing parameters and lower Cresp after discharge compared with non-CDH patients. Thoracic and abdominal surgery infants had similar FRCs at extubation (19.04¡6.0 and 18.88¡ 4.0 mL?kg -1 , respectively).…”

Section: Neonatal Critical Care H Proquitté Et Alsupporting

confidence: 91%

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Proquitté¹,

Freiberger²,

Yılmaz³

et al. 2009

European Respiratory Journal

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In newborn infants, thoraco-abdominal surgery is a serious intervention with respect to gas exchange and lung mechanics. This prospective clinical study compared surgery-induced changes in functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices with changes in conventional monitoring parameters.Of 29 ventilated newborns (mean weight 2,770¡864 g at surgery), 13, nine and seven underwent thoracic, abdominal or congenital diaphragmatic hernia (CDH) surgery, respectively. The multiple breath washout (MBWO) technique using heptafluoropropane as tracer gas (Babylog1 8000; Dräger, Lübeck, Germany) was performed ,6 h before surgery, 22-24 h after surgery and ,6 h before extubation. Gas exchange, respiratory mechanics, FRC and VI index data were recorded.Thoraco-abdominal surgery resulted in changes to FRC and VI indices in a procedure-specific manner; however, these changes were not reflected in conventional mechanical or ventilatory monitoring parameters. FRC decreased in non-CDH infants, while FRC increased and VI indices decreased in CDH infants. Despite improvements, the differences in FRC and VI between CDH and non-CDH infants indicated persistent impaired lung function in CHD infants.MBWO can be advantageously used to measure the effect of surgery on the lung. While FRC and VI indices changed following surgery, conventional monitoring parameters did not.KEYWORDS: Congenital diaphragmatic hernia, lung volume, mechanical ventilation, multiple breath washout, newborn infant, thoraco-abdominal surgery S urvival in newborn infants following corrective surgery for serious cardiac [1,2] or abdominal wall defects [3] or for congenital diaphragmatic hernia (CDH) [4] has improved over the last decade. Nevertheless, opening the thoracic cavity and/or abdominal wall remains a significant intervention with respect to temporary alterations in gas exchange and lung volume.In addition to ventilator monitoring, blood gas analyses and repeated radiographs are usually performed in ventilated infants to monitor clinical development. Meanwhile, commercial equipment is available to assess lung aeration by measuring functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices [5][6][7]. This noninvasive method is based on the multiple breath washout (MBWO) measurement technique using a tracer gas [8]. However, the equipment used for simultaneously measuring airflow and molar mass of the breathing gas is generally bulky and cumbersome for routine applications in intubated newborns or premature infants, and requires significant floor space [9]. We have recently validated a prototype of an extended neonatal ventilator for MBWO analysis in small ventilated piglets [10]. This apparatus uses a miniaturised lightweight gas sensor and heptafluoropropane (HFP) as the tracer gas.We hypothesised that this technique can be advantageously used in a clinical setting to measure the effect of surgery on the lung. The aim of the present prospective clinical study was the use of the HPF-MBWO technique to i...

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Section: Neonatal Critical Care H Proquitté Et Alsupporting

confidence: 91%

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Proquitté¹,

Freiberger²,

Yılmaz³

et al. 2009

European Respiratory Journal

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“…Roehr et al 24 found decreased C rs with normal R rs (compared to the control group) in infants after surgery for CDH at 44 weeks (range from 36-58) of postconceptional age. They also found a normal FRC value (measured by body-plethysmography at the time of testing).…”

Section: Discussionmentioning

confidence: 98%

“…The data on pulmonary function in CDH in early infancy are based on retrospective reviews from centers with limited numbers of patients [23][24][25][26] . The various degrees of pulmonary hypoplasia, the variety of postnatal management and differing testing techniques are the key factors which complicate the interpretation and comparison of studies.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities in pulmonary function in infants with high-risk congenital diaphragmatic hernia

Rygl¹,

Rounova²,

Jan³

et al. 2015

BIOMED PAP

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Aims. The aim of the study was to analyze lung growth and abnormality of infant pulmonary function tests (IPFT) in congenital diaphragmatic hernia (CDH) survivors younger than three years of age with respect to unfavorable prognostic factors. Methods. Thirty high-risk CDH survivors at the age of 1.32±0.54 years, body weight 9.76±1.25 kg were examined using IPFT: tidal breathing analysis, baby resistance/compliance, whole baby body plethysmography and rapid thoracoabdominal compression. Gore-Tex patch was used in 13% of patients (GORE group). Pulmonary hypertension was diagnosed and managed in 13% (iNO group). Standard protocols and appropriate reference values were used and obtained data were statistically analysed. Results. High incidence of peripheral airway obstruction (70%), increased value of functional residual capacity (FRC p ) 191.3±24.5 mL (126.5±36.9 % predicted; P < 0.0005), increased value of effective airway resistance (R eff ) 1.71±0.93 kPa.L -1 .s (144.4±80.1 % predicted; P < 0.01) and decreased specific compliance of the respiratory system (C rs /kg) 14.1±2.3 mL.kPa.kg -1 (i.e., 76.1±20.1 % predicted, P < 0.0005) was noted in infants with CDH in comparison with reference values. Increased value of FRC p was found in GORE group (165.7±51.9 versus 120.4±31.2, P < 0.02) and in iNO group (183.1±52.6 versus 117.8±25.7 mL; P < 0.0005). Conclusion. A high incidence of peripheral airway obstruction, an increased value of FRC p and decreased specific compliance of the respiratory system was noted in infants with CDH. Unfavorable prognostic factors (Gore-Tex patch, pulmonary hypertension) correlate with more severe alteration of pulmonary function in infants.

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“…FTT has been documented in young children with CDH [1][2][3][4][5][6][7][8][9]. It has been postulated to be the result of comorbidities that affect intake (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to thrive (FTT) is a well-recognized morbidity among congenital diaphragmatic hernia (CDH) survivors [1][2][3][4][5][6][7][8][9]. The incidence of growth retardation in the first 3 years of life has been reported to be up to 56%, with up to one third of survivors requiring a feeding tube (FT) for nutritional rehabilitation during infancy [2,7,8].…”

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confidence: 99%

Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence

Haliburton

Mouzaki

Chiang

et al. 2015

Journal of Pediatric Surgery

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Impaired somatic growth and delayed lung development in infants with congenital diaphragmatic hernia—evidence from a 10-year, single center prospective follow-up study

Cited by 23 publications

References 27 publications

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Abnormalities in pulmonary function in infants with high-risk congenital diaphragmatic hernia

Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence

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