Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors

Jennifer R. Benjamin; Kathryn E. Gustafson; P. Brian Smith; Kirsten M. Ellingsen; K. Brooke Tompkins; Ronald N. Goldberg; C. Michael Cotten; Ricki F. Goldstein

doi:10.1016/j.jpedsurg.2012.09.026

Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors

Jennifer R. Benjamin, Kathryn E. Gustafson, P. Brian Smith, Kirsten M. Ellingsen, K. Brooke Tompkins, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein

Pediatrics

Research output: Contribution to journal › Article › peer-review

30 Scopus citations

Abstract

Objective: Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study Design: Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher's exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results: Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p = 0.01), extracorporeal membrane oxygenation (ECMO; p = 0.02), days on ECMO (p = 0.01), days of mechanical ventilation (p = 0.049), and post-operative use of inhaled nitric oxide (p = 0.02) were found to be associated with NCD at early school age. Conclusions: CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood.

Original language	English
Pages (from-to)	730-737
Number of pages	8
Journal	Journal of Pediatric Surgery
Volume	48
Issue number	4
DOIs	https://doi.org/10.1016/j.jpedsurg.2012.09.026
State	Published - Apr 2013

Bibliographical note

Funding Information:
The authors would like to thank Discovery Labs for funding this study, as well as express their gratitude toward the children and families who participated in the study. Dr. Smith received support from NICHD 1K23HD060040-01 and DHHS-1R18AE000028-01 . This study was also supported in part by the Duke Translational Medicine Institute and CTSA grant ( UL1RR024128 ).

Keywords

BMI
CDH
ECMO
FIQ
Full Scale IQ
GER
NCD
NICU
PIQ
PPHN
Performance Scale IQ
RAD
TELD
Test of Early Language Development
VIQ
Verbal Scale IQ
WPPSI
Wechsler Preschool and Primary Scale of Intelligence
body mass index
congenital diaphragmatic hernia
extracorporeal membrane oxygenation
gastroesophageal reflux
iNO
inhaled nitric oxide
neonatal intensive care unit
neurocognitive delay
persistent pulmonary hypertension of the newborn
reactive airway disease

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health

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10.1016/j.jpedsurg.2012.09.026

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@article{7b2698e75b30461d9f8a6b03bb4f5454,

title = "Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors",

abstract = "Objective: Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study Design: Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher's exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results: Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p = 0.01), extracorporeal membrane oxygenation (ECMO; p = 0.02), days on ECMO (p = 0.01), days of mechanical ventilation (p = 0.049), and post-operative use of inhaled nitric oxide (p = 0.02) were found to be associated with NCD at early school age. Conclusions: CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood.",

keywords = "BMI, CDH, ECMO, FIQ, Full Scale IQ, GER, NCD, NICU, PIQ, PPHN, Performance Scale IQ, RAD, TELD, Test of Early Language Development, VIQ, Verbal Scale IQ, WPPSI, Wechsler Preschool and Primary Scale of Intelligence, body mass index, congenital diaphragmatic hernia, extracorporeal membrane oxygenation, gastroesophageal reflux, iNO, inhaled nitric oxide, neonatal intensive care unit, neurocognitive delay, persistent pulmonary hypertension of the newborn, reactive airway disease",

author = "Benjamin, {Jennifer R.} and Gustafson, {Kathryn E.} and Smith, {P. Brian} and Ellingsen, {Kirsten M.} and Tompkins, {K. Brooke} and Goldberg, {Ronald N.} and Cotten, {C. Michael} and Goldstein, {Ricki F.}",

note = "Funding Information: The authors would like to thank Discovery Labs for funding this study, as well as express their gratitude toward the children and families who participated in the study. Dr. Smith received support from NICHD 1K23HD060040-01 and DHHS-1R18AE000028-01 . This study was also supported in part by the Duke Translational Medicine Institute and CTSA grant ( UL1RR024128 ). ",

year = "2013",

month = apr,

doi = "10.1016/j.jpedsurg.2012.09.026",

language = "English",

volume = "48",

pages = "730--737",

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T1 - Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors

AU - Benjamin, Jennifer R.

AU - Gustafson, Kathryn E.

AU - Smith, P. Brian

AU - Ellingsen, Kirsten M.

AU - Tompkins, K. Brooke

AU - Goldberg, Ronald N.

AU - Cotten, C. Michael

AU - Goldstein, Ricki F.

N1 - Funding Information: The authors would like to thank Discovery Labs for funding this study, as well as express their gratitude toward the children and families who participated in the study. Dr. Smith received support from NICHD 1K23HD060040-01 and DHHS-1R18AE000028-01 . This study was also supported in part by the Duke Translational Medicine Institute and CTSA grant ( UL1RR024128 ).

PY - 2013/4

Y1 - 2013/4

N2 - Objective: Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study Design: Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher's exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results: Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p = 0.01), extracorporeal membrane oxygenation (ECMO; p = 0.02), days on ECMO (p = 0.01), days of mechanical ventilation (p = 0.049), and post-operative use of inhaled nitric oxide (p = 0.02) were found to be associated with NCD at early school age. Conclusions: CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood.

AB - Objective: Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study Design: Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher's exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results: Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p = 0.01), extracorporeal membrane oxygenation (ECMO; p = 0.02), days on ECMO (p = 0.01), days of mechanical ventilation (p = 0.049), and post-operative use of inhaled nitric oxide (p = 0.02) were found to be associated with NCD at early school age. Conclusions: CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood.

KW - BMI

KW - CDH

KW - ECMO

KW - FIQ

KW - Full Scale IQ

KW - GER

KW - NCD

KW - NICU

KW - PIQ

KW - PPHN

KW - Performance Scale IQ

KW - RAD

KW - TELD

KW - Test of Early Language Development

KW - VIQ

KW - Verbal Scale IQ

KW - WPPSI

KW - Wechsler Preschool and Primary Scale of Intelligence

KW - body mass index

KW - congenital diaphragmatic hernia

KW - extracorporeal membrane oxygenation

KW - gastroesophageal reflux

KW - iNO

KW - inhaled nitric oxide

KW - neonatal intensive care unit

KW - neurocognitive delay

KW - persistent pulmonary hypertension of the newborn

KW - reactive airway disease

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SN - 0022-3468

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JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

IS - 4

ER -

Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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