PMID- 27622588 OWN - NLM STAT- MEDLINE DCOM- 20170426 LR - 20181202 IS - 1531-5037 (Electronic) IS - 0022-3468 (Linking) VI - 52 IP - 3 DP - 2017 Mar TI - Neurodevelopmental outcomes at 5years of age in congenital diaphragmatic hernia. PG - 437-443 LID - S0022-3468(16)30284-6 [pii] LID - 10.1016/j.jpedsurg.2016.08.008 [doi] AB - OBJECTIVE: To evaluate neurodevelopmental sequelae in congenital diaphragmatic hernia (CDH) children at 5years of age. MATERIALS AND METHODS: The study cohort of 35 CDH patients was enrolled in our follow-up program between 06/2004 and 09/2014. The neurodevelopmental outcomes assessed at a median of 5years (range, 4-6) included cognition (Wechsler Preschool and Primary Scale of Intelligence [WPPSI], n=35), Visual-Motor-Integration (n=35), academic achievement (Woodcock-Johnson Tests of Achievement, n=25), and behavior problems (Child Behavior Check List [CBCL], n=26). Scores were grouped as average, borderline, or extremely low by SD intervals. RESULTS: Although mean Full (93.9+/-19.4), Verbal (93.4+/-18.4), and Performance (95.2+/-20.9) IQ were within the expected range, significantly more CDH children had borderline (17%) and extremely low (17%) scores in at least one domain compared to normative cohorts (P<0.02). The Visual-Motor-Integration score was below population average (P<0.001). Academic achievement scores were similar to expected means for those children who were able to complete testing. CBCL scores for the emotionally reactive (23%) and pervasive developmental problems scales (27%) were more likely to be abnormal compared to normal population scores (P=0.02 and P=0.0003, respectively). Autism was diagnosed in 11%, which is significantly higher than the general population (P<0.01). Univariate analysis suggests that prolonged NICU stay, prolonged intubation, tracheostomy placement, pulmonary hypertension, autism, hearing impairment, and developmental delays identified during infancy are associated with worse cognitive outcomes (P<0.05). CONCLUSION: The majority of CDH children have neurodevelopmental outcomes within the average range at 5years of age. However, rates of borderline and extremely low IQ scores are significantly higher than in the general population. CDH survivors are also at increased risk for developing symptoms of emotionally reactive and pervasive developmental problems. Risk of autism is significantly elevated. Disease severity and early neurological dysfunction appear to be predictive of longer-term impairments. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Danzer, Enrico AU - Danzer E AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: danzere@email.chop.edu. FAU - Hoffman, Casey AU - Hoffman C AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - D'Agostino, Jo Ann AU - D'Agostino JA AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Gerdes, Marsha AU - Gerdes M AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Bernbaum, Judy AU - Bernbaum J AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Antiel, Ryan M AU - Antiel RM AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Rintoul, Natalie E AU - Rintoul NE AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Herkert, Lisa M AU - Herkert LM AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Flake, Alan W AU - Flake AW AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Adzick, N Scott AU - Adzick NS AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Hedrick, Holly L AU - Hedrick HL AD - The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. LA - eng PT - Journal Article DEP - 20160830 PL - United States TA - J Pediatr Surg JT - Journal of pediatric surgery JID - 0052631 SB - IM MH - Behavior Rating Scale MH - Child MH - *Child Development MH - Child, Preschool MH - Female MH - Follow-Up Studies MH - Hernias, Diaphragmatic, Congenital/*complications MH - Humans MH - Male MH - Neurodevelopmental Disorders/*etiology MH - Neurologic Examination MH - Retrospective Studies MH - Risk MH - Severity of Illness Index MH - Time Factors OTO - NOTNLM OT - Autism OT - Behavioral problems OT - Congenital diaphragmatic hernia OT - Neurodevelopmental outcome OT - Pulmonary hypertension OT - Pulmonary hypoplasia OT - Socioeconomic status EDAT- 2016/09/14 06:00 MHDA- 2017/04/27 06:00 CRDT- 2016/09/14 06:00 PHST- 2015/12/29 00:00 [received] PHST- 2016/08/04 00:00 [revised] PHST- 2016/08/22 00:00 [accepted] PHST- 2016/09/14 06:00 [pubmed] PHST- 2017/04/27 06:00 [medline] PHST- 2016/09/14 06:00 [entrez] AID - S0022-3468(16)30284-6 [pii] AID - 10.1016/j.jpedsurg.2016.08.008 [doi] PST - ppublish SO - J Pediatr Surg. 2017 Mar;52(3):437-443. doi: 10.1016/j.jpedsurg.2016.08.008. Epub 2016 Aug 30.