A call for lifelong follow-up in CDH: identifying recurrence patterns and the importance of routine monitoring
Background - Congenital diaphragmatic hernia (CDH) is a severe developmental disorder characterized by pulmonary hypoplasia and pulmonary hypertension, leading to high neonatal morbidity and mortality. Despite improved survival, recurrence remains a relevant long-term complication, presenting either...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
March 2026
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| In: |
Journal of pediatric surgery
Year: 2026, Volume: 61, Issue: 3, Pages: 1-9 |
| ISSN: | 1531-5037 |
| DOI: | 10.1016/j.jpedsurg.2025.162825 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jpedsurg.2025.162825 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0022346825006724 
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| Author Notes: | Michaela Klinke, Meike Weis, Richard Martel, Christoph Mohr, Johannes Boettcher, Yannick Ledermann, Patrick Thees, Thomas Schaible, Florian Kipfmueller, Michael Boettcher, Julia Elrod |
| Summary: | Background - Congenital diaphragmatic hernia (CDH) is a severe developmental disorder characterized by pulmonary hypoplasia and pulmonary hypertension, leading to high neonatal morbidity and mortality. Despite improved survival, recurrence remains a relevant long-term complication, presenting either asymptomatically during follow-up or as acute emergencies. Understanding recurrence patterns, risk factors, and management is essential for optimizing outcomes. - Methods - Children undergoing surgical CDH repair between 2000 and 2023 were analyzed. Demographic, treatment, and follow-up data were collected. Recurrence was defined by imaging or clinical detection of post-repair diaphragmatic defects. Timing, clinical presentation, and management were recorded, and potential risk factors were evaluated. The role of routine surveillance in early detection was assessed. - Results - Among 1247 treated children, 104 recurrences were identified (8.3 %; 10.8 % of survivors). Median age at recurrence diagnosis was 398 days (range 11-6188); 66.7 % occurred by two years of age. At diagnosis, 34.5 % were asymptomatic, 29.9 % had respiratory symptoms and 25.3 % vomiting. Intraoperative complications such as ileus or volvulus occurred in 14.7 % of surgically managed cases and were consistently diagnosed by severe radiologic signs. Risk factors included intrathoracic liver position (p = 0.0089), left-sided defects (p = 0.0072), large defect size (p = 0.0343), low birth weight (p = 0.0037), and lower gestational age (p = 0.0389). In 60.0 % of surgically treated recurrences, an additional patch was required. - Conclusion - CDH recurrences occur across all ages and often remain asymptomatic. Structured lifelong follow-up facilitates early detection and intervention, preventing severe complications. These findings support routine surveillance and the establishment of standardized long-term care protocols. |
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| Item Description: | Online veröffentlicht: 25. November 2025, Artikelversion: 26. Dezember 2025 Gesehen am 09.02.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1531-5037 |
| DOI: | 10.1016/j.jpedsurg.2025.162825 |