Introduction:
Chest surgeries, tumor, trauma and infections are main etiologies of Diaphragmic Paralysis(DP). DP can be asymptomatic or symptomatic depending on the age, etiology and number of diaphragms involved. Most works in children describe DP after cardiac surgeries. Present work describes largest and most diverse so far cohort of pediatric patients with DP, giving broadest picture of its etiologies, comorbidities, recovery chances and risk factors for diaphragmic plication(DPL).
Methods:
Data from Pediatric, Cardiac and Neonatology Intensive Care Units of E&L Safra Children`s Hospital from 2010-2017 was analyzed. Data on pediatric patients with proven DP and DPL among patients after cardiac surgeries and "non-cardiac" related sub-populations was reviewed. The primary outcome was to compare DP among patients after cardiac surgeries and non-cardiac related etiologies and risk factors for DPL performance and recovery.
Results:
A total 88 patients, of them 30(34.1%) with non-cardiac etiology, with diagnosed DP were included in the study,27(30.7%) of them underwent DPL. Murray Lung Injury score(LIS), was found to be significantly higher in both, patients after cardiac surgeries(2.1,p=0.05) and patients who underwent DPL(2.25,p=0.012). Performed DPL significantly shortened time of mechanical ventilation, to one day after DPL,p=0.015. Young age, CNS, Respiratory and CVS systems involvement, each, showed to statistically increase the risk of DPL(p=0.002, p=0.004,p=0.002, p=0.05 respectfully).
Conclusions:
Non-cardiac causes of DP are very frequent in pediatric population. Non-cardiac and patients after cardiac surgeries with young age, CNS, Respiratory and CVS systems involvement carry higher risk for DPL performance. LIS score can be used to predict need for DPL performance in both populations.
