J Pediatr Surg
. 2025 Nov 25:162825.
doi: 10.1016/j.jpedsurg.2025.162825. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41308828/
A Call for Lifelong Follow-Up in CDH: Identifying Recurrence Patterns and the Importance of Routine Monitoring
Michaela Klinke 1, Meike Weis 2, Richard Martel 1, Christoph Mohr 1, Johannes Boettcher 3, Yannick Ledermann 1, Patrick Thees 1, Thomas Schaible 4, Florian Kipfmueller 4, Michael Boettcher 1, Julia Elrod 5
Affiliations Expand
- PMID: 41308828
- DOI: 10.1016/j.jpedsurg.2025.162825
Free article
Abstract
Background: Congenital diaphragmatic hernia (CDH) is a severe developmental disorder characterized by pulmonary hypoplasia and pulmonary hypertension, leading to high neonatal morbidity and mortality. Despite improved survival, recurrence remains a relevant long-term complication, presenting either asymptomatically during follow-up or as acute emergencies. Understanding recurrence patterns, risk factors, and management is essential for optimizing outcomes.
Methods: Children undergoing surgical CDH repair between 2000 and 2023 were analyzed. Demographic, treatment, and follow-up data were collected. Recurrence was defined by imaging or clinical detection of post-repair diaphragmatic defects. Timing, clinical presentation, and management were recorded, and potential risk factors were evaluated. The role of routine surveillance in early detection was assessed.
Results: Among 1,247 treated children, 104 recurrences were identified (8.3%; 10.8% of survivors). Median age at recurrence diagnosis was 398 days (range 11-6,188); 66.7% occurred by two years of age. At diagnosis, 34.5% were asymptomatic, 29.9% had respiratory symptoms and 25.3% vomiting. Intraoperative complications such as ileus or volvulus occurred in 14.7% of surgically managed cases and were consistently diagnosed by severe radiologic signs. Risk factors included intrathoracic liver position (p = 0.0089), left-sided defects (p = 0.0072), large defect size (p = 0.0343), low birth weight (p = 0.0037), and lower gestational age (p = 0.0389). In 60.0% of surgically treated recurrences, an additional patch was required.
Conclusion: CDH recurrences occur across all ages and often remain asymptomatic. Structured lifelong follow-up facilitates early detection and intervention, preventing severe complications. These findings support routine surveillance and the establishment of standardized long-term care protocols.
Keywords: CDH; congenital diaphragmatic hernia; follow up; recurrence.
Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.
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