Gischler Saskia J, van der Cammen-van Zijp Monique H M, Mazer Petra, Madern Gerard C, Bax Nikolaas M A, de Jongste Johan C, van Dijk Monique, Tibboel Dick, Ijsselstijn Hanneke
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
J Pediatr Surg. 2009 Sep;44(9):1683-90. doi: 10.1016/j.jpedsurg.2008.12.019.
The aim of the study was to compare long-term respiratory morbidity in children after repair of esophageal atresia (EA) or congenital diaphragmatic hernia (CDH).
Children were seen at 6, 12, and 24 months and 5 years within a prospective longitudinal follow-up program in a tertiary children's hospital. Respiratory morbidity and physical condition were evaluated at all moments. At age 5 years, pulmonary function and maximal exercise performance were tested.
In 3 of 23 atresia patients and 10 of 20 hernia patients, bronchopulmonary dysplasia was developed. Seventeen atresia and 11 hernia patients had recurrent respiratory tract infections mainly in the first years of life. At age 5, 25% of EA and CDH patients measured showed reduced forced expiratory volume in 1 second (z-score < -2). Both atresia and hernia patients showed impaired growth, with catch-up growth at 5 years in patients with EA but not in those with hernia. Maximal exercise performance was significantly below normal for both groups.
Esophageal atresia and CDH are associated with equal risk of long-term respiratory morbidity, growth impairment, and disturbed maximal exercise performance. Prospective follow-up of EA patients aimed at identifying respiratory problems other than tracheomalacia should be an integral part of interdisciplinary follow-up programs.
本研究旨在比较食管闭锁（EA）或先天性膈疝（CDH）修复术后儿童的长期呼吸系统发病率。
在一家三级儿童医院的前瞻性纵向随访项目中，于6个月、12个月、24个月及5岁时对儿童进行观察。在各个时间点评估呼吸系统发病率和身体状况。在5岁时，测试肺功能和最大运动能力。
23例闭锁患者中有3例、20例疝患者中有10例发生支气管肺发育不良。17例闭锁患者和11例疝患者主要在生命的头几年反复发生呼吸道感染。在5岁时，测量的EA和CDH患者中有25%的1秒用力呼气量降低（z评分＜-2）。闭锁患者和疝患者均出现生长发育受损，EA患者在5岁时出现追赶生长，而疝患者则未出现。两组的最大运动能力均显著低于正常水平。
食管闭锁和CDH与长期呼吸系统发病率、生长发育受损及最大运动能力受干扰的风险相当。针对EA患者进行旨在识别除气管软化以外的呼吸问题的前瞻性随访，应成为跨学科随访项目的一个组成部分。
