Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors

Abstract

Objective Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study design Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher’s exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p=0.01), extracorporeal membrane oxygenation (ECMO; p=0.02), days on ECMO (p=0.01), days of mechanical ventilation (p=0.049), and post-operative use of inhaled nitric oxide (p=0.02) were found to be associated with NCD at early school age. Conclusions CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood.

Neurodevelopmental outcome in congenital diaphragmatic hernia survivors: role of ventilatory time

“…This is consistent with Friedman et al who reported VT as the only independent predictor of motor problems at 12 months in CDH survivors [4]. Benjamin et al found that duration of mechanical ventilation was predictive of neurocognitive delay at early school age while Danzer in a longitudinal study reported that in the first 3 years of life prolonged ventilation tended to be associated with persistent adverse neuromotor outcome [15,17].…”

Neurodevelopmental Outcomes After Neonatal Surgery for Major Noncardiac Anomalies

“…After screening of title/abstract followed by full text, 23 papers 6,7,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] reporting on 895 children met our inclusion and exclusion criteria and were selected for systematic review (Table 1). There was a wide range in follow-up duration and time of assessment from 12 months up to 60 months of age.…”

“…Risk factors that negatively influence neurodevelopment include low birth weight, 6 higher number of congenital anomalies, 7 a longer hospital stay, 7,26,28,40 duration of mechanical ventilation, 29,31,35,40,42 and need for supplemental oxygen at discharge. 26 However, data to evaluate longer-term neurocognitive outcomes associated with these risk factors were limited in the studies that were included in this review.…”

“…A higher number of congenital anomalies also significantly increased the risk of neurodevelopmental delay. 7,30,37 Neuroimaging with either cerebral ultrasonography, CT, or MRI scanning was reported in 11 studies, 7,26,27,31,34,35,[40][41][42]45,47 and 10 of these articles reported solely on CDH. In 7 studies, 7,34,[40][41][42]45,47 the correlation between brain damage and neurodevelopmental outcome was not explored, and in 4 studies, 26,27,31,35 no significant correlation was found.…”

“…7,26,28,37,40 A higher number of surgical interventions was found to be correlated with a lower cognitive and motor outcome. 6,7,29,30,37 Duration of mechanical ventilation 29,31,35,37,40,42 and the need for supplemental oxygen at discharge 26 were both reported as risk factors for neurodevelopmental delay.…”