Development and selected complications in children with congenital diaphragmatic hernia during the first four years of life – a single-center study from a paediatric hospital in Warsaw

Introduction
The aim of our study was to evaluate development and selected complications in children with congenital diaphragmatic hernia (CDH) during the first four years of life. This single-centre study was conducted at a paediatric hospital in Warszawa. We focused on the relationship between anthropometric measurements, CDH occurrence, and the development of complications.

Material and methods
We conducted a survey study aimed at parents of children with CDH who had undergone surgical treatment in 2007–2021. The questionnaire consisted of 11 sections, including an introduction, consent for participation, and questions concerning anthropometric measurements, gastroenterological and pneumonological complications. Respondents were also asked about rarer CDH-associated complications.

Results
We identified 121 children with CDH, and 90 parents completed the survey: 75 (83.33%) with left-sided hernia, 17 (18.89%) with another congenital accompanying anomaly. Recurrence of the hernia occurred in 21 (23.33%) cases, with 90.48% of recurrences occurring on the left side. Significant changes were observed in the percent distribution of patients on growth, weight, and body mass index (BMI) centile charts during the first two years of life. At birth, 55.56% of children (50/90) were above the 97th percentile for height, and 42.22% (38/90) were below the 3rd percentile for BMI. In the second year of life, these values were 11.69% (9/77) and 24.68% (19/77), respectively. A relationship was found between the recurrence of diaphragmatic hernia and the surgery with the patch (p = 0.002) as well as the presence of lung hypoplasia (p = 0.001). No correlation was found between symptoms and diaphragmatic hernia lateralization.

Conclusions
The study highlights the impact of CDH on physical development and gastroenterological and pulmonological complications. Early growth deficiencies were common, improving from the second month. Hernia recurrence correlated with lung hypoplasia and patch surgery, and gastro-oesophageal reflux disease was frequent. Long-term multidisciplinary follow-up is essential, and further research on larger cohorts is needed to clarify complications’ impact.