Lung function at follow-up of infants with surgically correctable anomalies

Infants with congenital diaphragmatic hernia (CDH) or anterior wall defects (AWD) can suffer abnormal antenatal lung growth, the risk, however, may be greater for CDH infants. The objectives of this study were to test the hypothesis that following surgical correction, CDH infants would have worse lung function at follow-up than AWD infants and to determine whether fetal lung volume (FLV) results correlated with the lung function results at follow-up.

Thirteen infants with CDH and 13 infants with AWD had lung function measurements at a median age of 11 (range 6–24) months; 17 of the infants had had their FLV assessed.

Lung function was assessed by plethysmographic measurement of lung volume (FRCpleth) and airway resistance (Raw). In addition, functional residual capacity was assessed by a helium gas dilution technique (FRCHe); tidal breathing parameters (TPTEF:Te) and compliance and resistance of the respiratory system (Crs and Rrs, respectively) were also determined. FLV was assessed using three-dimensional (3D) ultrasound and virtual organ computer aided analysis.

The CDH compared to the AWD infants had a higher median FRCpleth (41 ml/kg vs. 37 ml/kg, P = 0.043) and a lower median Crs (1.45 ml/cm H2O/kg vs. 2.78 ml/cm H2O/kg, P = 0.041). FRCpleth results correlated significantly with FLV results (r = 0.721, P < 0.001).

In conclusion, infants with CDH had significantly different lung function at follow-up than AWD infants. Our findings suggest FLV results may predict lung function abnormalities at follow-up in infants with surgically correctable anomalies.