J Pediatr
. 2025 Dec 20:114964.
doi: 10.1016/j.jpeds.2025.114964. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41429283/
Neurodevelopmental Outcome Following Open Repair of Congenital Diaphragmatic Hernia with and without ECMO Support: A Prospective Longitudinal Study
Rainer Kubiak 1, Thomas Schaible 2, Christel Weiss 3, Michael Boettcher 4, Katrin B Zahn 4
Affiliations Expand
- PMID: 41429283
- DOI: 10.1016/j.jpeds.2025.114964
Abstract
Objective: To identify the incidence and risk factors for neurodevelopmental delay in a longitudinal cohort of children with congenital diaphragmatic hernia (CDH) with and without support with extracorporeal membrane oxygenation (ECMO).
Study design: We prospectively followed until March 2022 those children who underwent open CDH repair between 2009 and 2018 at a single institution. Standardized assessments of cognitive, language, and motor development were conducted from 6 months to 6 years of age. Delays were defined using standard deviation thresholds. Univariable and multivariable logistic regression analyses identified risk factors for neurodevelopmental delay.
Results: Of 278 patients (130 ECMO, 148 non-ECMO), 784 assessments were completed. Cognitive delays were more common in the ECMO group; language and motor outcomes were similar. Most delays were mild. Most children had no delays in any domain by 6 years of age. In multiple regression analyses, risk factors for delays varied at different timepoints. Re-operation during the first year was negatively associated with 2-4 year cognitive function (OR 3.5, 95% CI:1.3-9.8), expressive language (OR 2.7, 95% CI:1.0-7.2), and motor delays (OR 2.4; 95% CI:1.1-5.1). At 4 years, motor delays were associated with antenatal fetoscopic endoluminal tracheal occlusion (OR 4.9, 95% CI:1.2-20.1) and abdominal wall patch (OR 4.8, 95% CI:1.7-13.9).
Conclusions: Most children with CDH achieved normal neurodevelopment by school age. ECMO use was associated with early cognitive delays. Disease severity and surgical factors were associated with increased risk of delays, suggesting that meticulous surgical technique may protect neurodevelopmental outcomes. Timely support and standardized neurological follow-up may help to prevent or reduce long-term problems.
Copyright © 2025. Published by Elsevier Inc.
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