Work

Impact of Surgical Diaphragmatic Repair on Central Airway Shape in Neonatal Congenital Diaphragmatic Hernia

Year: 2026

Type: article

Abstract: RATIONALE: Neonates with congenital diaphragmatic hernia (CDH) frequently experience central airway abnormalities, including tracheobronchomalacia, which persist post-surgical repair. However, these complications often remain underdiagnosed due to reliance on symptomatic evaluation and limited use of bronchoscopy. Ultrashort echo time (UTE) magnetic resonance imaging (MRI) offers a non-invasive, three-dimensional method to assess airway dynamics and evaluate tracheobronchomalacia. OBJECTIVES: To quantify changes in central airway morphology and dynamics before and after surgical diaphragmatic repair in neonates with CDH using UTE MRI. METHODS: This study examined neonates with CDH admitted between 2015 and 2020 who underwent both pre- and post-surgical UTE MRI. Airway dynamics were assessed using respiratory-gated radial three-dimensional UTE images at four breathing phases. Three-dimensional airway surfaces were generated from the cricoid to the main bronchi. Changes from pre- to post-surgery in cross-sectional areas, dynamic collapse, and eccentricity index were analyzed. RESULTS: Six neonates with left-sided CDH were included. Following surgery, tracheal minimum eccentricity index at end expiration decreased significantly (0.68 ± 0.06 to 0.53 ± 0.15, p = 0.023), indicating increased collapse. The ipsilateral bronchus demonstrated similar changes, with eccentricity index decreasing significantly from 0.65 ± 0.04 to 0.55 ± 0.11 (p = 0.048), while the contralateral bronchus remained stable. Mean tracheal cross-sectional area decreased from 22.7 ± 6.1 mm² to 19.1 ± 3.1 mm² (p = 0.115), while dynamic motion increased from 21 ± 7% to 40 ± 15% (p = 0.055). CONCLUSIONS: Neonates with CDH have significant central airway abnormalities pre-surgery, which persists and may worsen post-repair, particularly in the trachea and ipsilateral bronchus. These findings suggest tracheobronchomalacia is an underrecognized component of CDH. Integrating airway assessment into surgical planning could improve post-operative outcomes.

Source: Pediatric Pulmonology

DOI: 10.1002/ppul.71493