Risk of Readmission for Wheezing during Infancy in Children with Congenital Diaphragmatic Hernia

Abstract

RationaleCongenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization during infancy, although actual frequency of readmissions is unknown.ObjectiveWe aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission.MethodsData about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database.ResultsNinety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctor’s visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization.ConclusionsThe rate of readmission for wheezing among infants with CDH is high, and significantly influenced by several prenatal and neonatal factors. Palivizumab prophylaxis was not associated with the rate of readmission.

Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany

“…The median treatment duration until discharge according to recent publications is 31 days (excluding ECMO patients) [ 17 ], 32 days [ 45 ], 38 days [ 25 ], 39 days [ 41 ], and 39 days [ 53 ]. Re-hospitalizations are an additional burden [ 53 , 54 ] and reflect long-term morbidity [ 55 ]. Our study includes re-admissions after the first release from the hospital, which explains the longer treatment time in our study (40 days) and gives additional insights into the treatment course of CDH patients.…”

Pulmonary hypertension is an important co‐morbidity in developmental lung diseases of infancy: Bronchopulmonary dysplasia and congenital diaphragmatic hernia

“…After recent modifications, the definitions of PH in children and adults are now consistent across patient populations 23,24 . The current definition, with measurements acquired during cardiac catheterization, requires a mean PAP > 20 mmHg with an elevated PVR ≥ 3 WU (PVRi ≥ 3 WU∙m 2 in children, indexed to body surface area), consistent with PVD and independent of any shunt due to cardiovascular communications. In pediatric PH, the child must be greater than 3 months of age by this definition, to allow for the usual fall in PVR after birth 24 .…”

“…Bronchopulmonary dysplasia (BPD) following preterm birth and congenital diaphragmatic hernia (CDH) are developmental lung diseases that may result in persistent airway and pulmonary vascular morbidity in childhood. Recurrent hospitalization for respiratory decompensation, often in the setting of intercurrent infection, may be accompanied by evidence of elevated right heart pressures and pulmonary vascular resistance (PVR) 1‐3 . Thus, an understanding of the evaluation and trajectory of children with these disorders, as reviewed here, is important for those providing ongoing care in childhood.…”

Respiratory syncytial virus bronchiolitis in congenital diaphragmatic hernia: A systematic review of prevalence rates and palivizumab prophylaxis

“…All three papers were retrospective cohort studies. Two 28,30 Assessments of study quality for each included paper are included in Table E2. In short, studies were of poor quality.…”