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

J Pediatr Surg. 2015 Mar;50(3):394-8. doi: 10.1016/j.jpedsurg.2014.05.039. Epub 2014 Jul 28.

Abstract

Background: Neurodevelopmental impairment is one of the most significant morbidities among CDH survivors.

Purpose: Assess correlation between ventilatory time (VT) and short-term neurodevelopmental outcome in congenital diaphragmatic hernia (CDH) survivors.

Methods: A prospective longitudinal study was conducted between 2008 and 2012. Assessment of mental and motor development was performed at 6 and 12months by Bayley Scales of Infant and Toddler Development - 3rd Edition (BSID-III). ROC curve analysis was used.

Results: Forty-two subjects were included in the study. There was a significant inverse correlation between neurodevelopment at 6 and 12months and VT during first admission (p<0.0001). VT predicting the risk of moderate (BSID-III <85) and severe (BSID-III <70) delay was 13 and 28days, respectively (area under the curve - delay <85: 6months mental 0.943 and motor 0.992; 12months mental 0.877 and motor 0.925; delay <70: 6months mental 0.934 and motor 0.943; 12months mental 0.906 and motor 0.975; p<0.0001).

Conclusions: VT should be considered an important marker to identify subjects at risk for short-term neurodevelopmental delay in CDH survivors. Early follow-up intervention therapy should be activated in every baby with a history exceeding 13days of VT.

Keywords: Congenital diaphragmatic hernia; Neurodevelopmental outcome; Ventilatory strategy.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Developmental Disabilities / epidemiology
  • Developmental Disabilities / etiology*
  • Female
  • Follow-Up Studies
  • Hernias, Diaphragmatic, Congenital / complications*
  • Hernias, Diaphragmatic, Congenital / therapy
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Italy / epidemiology
  • Male
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Survival Rate / trends