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Quality of life and morbidity in children after repair of congenital diaphragmatic hernia


Authors: P. Rounová;  D. Zemková 1;  J. Šulc 1;  K. Pýcha;  Z. Straňák 2;  T. Svobodová 1;  M. Kynčl 3;  J. Šnajdauf;  M. Rygl
Authors‘ workplace: Klinika dětské chirurgie UK 2. LF a FN Motol, subkatedra dětské chirurgie IPVZ, Praha přednosta prof. MUDr. J. Šnajdauf, DrSc. ;  Pediatrická klinika UK 2. LF a FN Motol, Praha přednosta prof. MUDr. J. Lebl, CSc. 1;  Ústav pro péči o matku a dítě UK 3. LF, Praha přednosta doc. MUDr. Z. Straňák, CSc. 2;  Klinika zobrazovacích metod UK 2. LF a FN Motol, Praha přednosta doc. MUDr. M. Roček, CSc. 3
Published in: Čes-slov Pediat 2012; 67 (6): 368-375.
Category: Original Papers

Overview

Aim of the study:
The aim of this study is to assess the health status and quality of life in children operated on after birth for congenital diaphragmatic hernia (CDH).

Methods:
A retrospective-prospective study of health status and quality of life in children operated in 1997–2009 for congenital diaphragmatic hernia. Analyzed data were obtained from medical records, questionnaires filled in by parents and clinical examination in 57 children after CDH repair (33 boys, 24 girls), mean age at examination was 6.5 years (11 months to 14.5 years).

Results:
The overall quality of life was assessed by the parents as good in 43 children (77%), satisfactory in 11 children (20%), unsatisfactory in 2 children (3%). None of the parents rated the quality of life as bad. Seventeen children (30%) have respiratory problems, and asthma was confirmed in 6 patients (11%). Clinical symptoms of gastroesophageal reflux (GER) occurred in 15 children (26%), in 16 children (28%) GER was sonographically detected. Two patients (4%) required Nissen fundoplication. Nonspecific digestive problems occurred in 25% of children. Scoliosis was found in 5%, poor posture in 33% and pectus excavatum in 42% of patients. Compared to the population norm CDH children had a significantly lower body height SDS (mean -0.39, p<0.05), weight SDS (mean –0.75, p<0.001) and BMI SDS (mean -0.68, p<0.001). Neurological problems were observed in 16 children (28%). The children mostly have neurodevelopmental delay (81%) especially in the first months of life which is normalised in the most of the patients during the first years of life. Social adaptation was evaluated in 33 older children (mean age 9.7 years). Thirty children (91%) attended primary school, 2 children special primary school, one child is in a special kindergarten. Twenty seven children (82%) of 33 children competed in sports or participate in gym class without any problems.

Conclusion:
Despite a greater incidence of problems when compared to healthy population, the health status and quality of life in children after surgery of CDH seems to be satisfactory.

Key words:
congenital diaphragmatic hernia, anthropometric examination, gastroesophageal reflux, long-term morbidity, quality of life


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Labels
Neonatology Paediatrics General practitioner for children and adolescents
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