J Pediatr Surg
. 2026 Jan 9:162927.
doi: 10.1016/j.jpedsurg.2026.162927. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41520816/
Evaluation of Swallow Function in Patients with Congenital Diaphragmatic Hernia
Nzuekoh N Nchinda 1, Eustina G Kwon 2, Carrie Foster 3, Mihai Puia-Dumitrescu 4, Jimiane L Ashe 3, Akila B Ramaraj 5, Matthew B Dellinger 6, Kimberly J Riehle 6, Samuel E Rice-Townsend 6, Rebecca A Stark 6
Affiliations Expand
- PMID: 41520816
- DOI: 10.1016/j.jpedsurg.2026.162927
Abstract
Purpose: Children with congenital diaphragmatic hernia (CDH) are vulnerable to lung injury secondary to aspiration and have an elevated risk of dysphagia. This study assesses video fluoroscopic swallow study (VFSS) utilization to detect aspiration and aims to identify prenatal indicators of swallow dysfunction in infants with CDH.
Methods: This is a single center, retrospective observational study of infants with CDH born between January 2014 and October 2022. VFSS results were analyzed, along with potential associations between aspiration and lung-to-head ratio (LHR) or the presence of polyhydramnios.
Results: A total of 105 infants were included. The majority of patients were born at term (87, 83%), had left-sided CDH (81, 77%), and underwent patch repair (56, 53%). Most patients (78, 74%) were discharged with a feeding tube for supplementary nutrition. Twenty patients (19%) had a VFSS performed prior to discharge, and an additional 29 patients (28%) completed outpatient VFSS within five years of discharge. The majority of patients with inpatient VFSS (12, 60%) showed aspiration compared to 10 patients (35%) who had outpatient VFSS. CDH size, laterality, repair type, LHR, and polyhydramnios were not consistently associated with aspiration on VFSS. For most patients who received inpatient VFSS (11, 92%), findings resulted in changes in feeding management.
Conclusion: Although most infants with congenital diaphragmatic hernia required tube feeds due to feeding difficulties, less than half underwent formal VFSS. In the absence of consistent predictors, a low threshold for initiating formal swallow evaluation in patients with CDH is recommended.
Keywords: congenital diaphragmatic hernia; feeding difficulty; video fluoroscopic swallow study.
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