Outcome and Clinical Characteristics of Diaphragm Dysfunction After Pediatric Cardiac Surgery: From Detection to Plication.

BACKGROUND

Diaphragm paralysis (DP) due to phrenic nerve injury is a rare but serious complication of pediatric cardiac surgery (0.3-5% of cases). It presents as an extubation failure or difficulty weaning from ventilation. Early recognition and management are essential.

OBJECTIVES

This study aimed to evaluate the incidence, clinical characteristic and outcome of diaphragm paralysis after heart surgery in children.

METHODS

A retrospective single-center review (2019-2024) was conducted of ultrasound-confirmed DP case. Demographics, surgical details, ventilatory course, interventions, and outcomes were analyzed. Partial and complete DP were compared using multivariate logistic regression to identify predictors.

RESULTS

Out of 2280 surgeries, 108 children (4.7 %) developed DP, with 75 % being infants (median age 6.3 months). Partial paresis happened in 2.9 % and complete paralysis in 1.8 %. The left side was affected most, 46 % of total cases. Children with complete DP were younger (median 5.8 vs 7.4 months, p < 0.05) and most had an open sternum. Plication was done in 40 % of complete DP cases, none in partial cases. Complete DP led to longer hospital stays (26 vs 21 days, p < 0.05). Male sex (OR 3.76, p < 0.01) and open sternum (OR 3.26, p < 0.05) were independent predictors of complete paralysis. Survival was 93.

CONCLUSION

Diaphragm paralysis after heart surgery is a serious problem in children, especially infants. Partial paralysis improved with non-invasive ventilation and physiotherapy, but complete paralysis often need surgery. Protecting the phrenic nerve, using early imaging, and the prompt actions may improve the outcome.