[size=20px]An eleven month old infant with a history of CDH repaired with a patch returns to a follow-up clinic with poor weight gain, persistent cough, and a normal CXR.

 

What is the next best step in this infant’s management?

 

A Change formula

 

B Video fluoroscopic swallow study

 

C Laparoscopic Nissen fundoplication

 

D Placement gastrostomy tube

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C

C

B

B

B

B

B

B

B

B

B

B

Correct answer

B Video fluoroscopic swallow study

 

Many children with CDH suffer from an uncoordinated swallow which leads to poor feeding and potential pulmonary issues. Ramaraj (2021) reported findings of an abnormal swallow study in over one third of the CDH population at one institution. Most (80%) of those children were able to be managed by altering the consistency of the oral feeds. If these measures are not successful in resolving malnutrition symptoms or the infant has aspiration of all food consistencies then consideration should be given to performing a gastrostomy for feeding.

 

Gastroesophageal reflux is a common issue in children who have undergone CDH repair and has been reported to be responsible for as many as 20% of hospital readmissions for CDH. Because many of these children have uncoordinated swallowing, further investigation prior to fundoplication would include a swallow study and a pH or impedance probe study.