Pediatr Pulmonol
. 2026 Feb;61(2):e71493.
doi: 10.1002/ppul.71493. https://pubmed.ncbi.nlm.nih.gov/41676944/
Impact of Surgical Diaphragmatic Repair on Central Airway Shape in Neonatal Congenital Diaphragmatic Hernia
Chamindu C Gunatilaka 1, Sahr Alisher 2, Margo Waters 3, Qiwei Xiao 1, Xavier Hoyos Cordon 1 4, Nara S Higano 1, Jason C Woods 1 5 6, Paul Kingma 6 7, Alister J Bates 1 4 5 6
Affiliations Expand
- PMID: 41676944
- PMCID: PMC12895503
- DOI: 10.1002/ppul.71493
Abstract
Rationale: Neonates with congenital diaphragmatic hernia (CDH) frequently experience central airway abnormalities, including tracheobronchomalacia, which persist post-surgical repair. However, these complications often remain underdiagnosed due to reliance on symptomatic evaluation and limited use of bronchoscopy. Ultrashort echo time (UTE) magnetic resonance imaging (MRI) offers a non-invasive, three-dimensional method to assess airway dynamics and evaluate tracheobronchomalacia.
Objectives: To quantify changes in central airway morphology and dynamics before and after surgical diaphragmatic repair in neonates with CDH using UTE MRI.
Methods: This study examined neonates with CDH admitted between 2015 and 2020 who underwent both pre- and post-surgical UTE MRI. Airway dynamics were assessed using respiratory-gated radial three-dimensional UTE images at four breathing phases. Three-dimensional airway surfaces were generated from the cricoid to the main bronchi. Changes from pre- to post-surgery in cross-sectional areas, dynamic collapse, and eccentricity index were analyzed.
Results: Six neonates with left-sided CDH were included. Following surgery, tracheal minimum eccentricity index at end expiration decreased significantly (0.68 ± 0.06 to 0.53 ± 0.15, p = 0.023), indicating increased collapse. The ipsilateral bronchus demonstrated similar changes, with eccentricity index decreasing significantly from 0.65 ± 0.04 to 0.55 ± 0.11 (p = 0.048), while the contralateral bronchus remained stable. Mean tracheal cross-sectional area decreased from 22.7 ± 6.1 mm² to 19.1 ± 3.1 mm² (p = 0.115), while dynamic motion increased from 21 ± 7% to 40 ± 15% (p = 0.055).
Conclusions: Neonates with CDH have significant central airway abnormalities pre-surgery, which persists and may worsen post-repair, particularly in the trachea and ipsilateral bronchus. These findings suggest tracheobronchomalacia is an underrecognized component of CDH. Integrating airway assessment into surgical planning could improve post-operative outcomes.
Keywords: airway analysis; congenital diaphragmatic hernia; neonates; surgical outcome; tracheobronchomalacia.
© 2026 The Author(s). Pediatric Pulmonology published by Wiley Periodicals LLC.
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