Background:
In the pediatric population diaphragmatic paralysis (DP) is mainly described in consequence of congenital heart defect repair surgeries. Depending on clinical basis and etiology, some patients would need diaphragmatic plication (DPL). To date, guidelines regarding patient selection for DPL are lacking. Our objectives were to describe etiologies of DP in pediatric patients with emphasis on non-cardiac surgery related etiologies and to determine risk factors and predicators for DPL performance.
Methods:
Retrospective data on patients with DP from the pediatric, cardiac and neonatal intensive care departments of Safra children`s hospital was reviewed. The primary outcomes were DP etiologies and DPL performance.
Results:
DP was diagnosed in 88 patients, 29 (33%) with non-cardiac surgery related etiologies (e.g. congenital, surgery, trauma and shock). 27 (31%) patients underwent DPL, compared with patients who did not undergo DPL, these patients had: significant co-morbidities involving respiratory, central nervous and cardiovascular systems, higher lung injury score and lower weight (P=0.002, P=0.002, P<0.001, P=0.012, P=0.013, respectively). Multivariate regression model revealed significant independent predictors for DPL including involvement of central nervous (OR 9.651, P=0.005), respiratory (OR 4.875, P=0.039), cardiovascular systems (OR 23.938, P=0.001) and younger age (OR 0.996, P=0.021).
Conclusions:
We conclude that non-cardiac surgery etiologies of DP are very diverse in the pediatric population. Ventilated pediatric patients with DP from various etiologies, who are with young age and co-morbidities involving respiratory, central nervous and cardiovascular systems carry high risk for DPL performance. In these patients who fail to wean from ventilation early DPL should be highly considered.
