{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:36:27Z","timestamp":1791358587613,"version":"4.3.1"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Diaphragmatic paralysis following congenital cardiac surgery is associated with significant morbidity and mortality. Spontaneous recovery of diaphragmatic function has been described, contrasting with centres providing early diaphragmatic plication. We aimed to describe the outcomes of a conservative approach, as well as to identify factors associated with a failure of the strategy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>This is a retrospective study of patients admitted after cardiac surgery and suffering unilateral diaphragmatic paralysis within 2 French Paediatric Cardiac Surgery Centers. The conservative approach, defined by the prolonged use of ventilation until successful weaning from respiratory support, was the primary strategy adopted in both centres. In case of unsuccessful evolution, a diaphragmatic plication was scheduled. Total ventilation time included invasive and non-invasive ventilation. Diaphragm asymmetry was defined by the number of posterior rib segments counted between the 2 hemi-diaphragms on the chest X-ray after cardiac surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Fifty-one neonates and infants were included in the analysis. Patients\u2019 median age was 12.0\u2009days at cardiac surgery (5.0\u201382.0), and median weight was 3.5\u2009kg (2.8\u20134.9). The conservative approach was successful for 32\/51 patients (63%), whereas 19\/51 patients (37%) needed diaphragm plication. There was no difference in patients\u2019 characteristics between groups. Respiratory support prolonged for 21\u2009days or more and diaphragm asymmetry more than 2 rib segments were independently associated with the failure of the conservative strategy [odds ratio (OR) 6.9 (1.29\u201337.3); P\u2009=\u20090.024 and OR 6.0 (1.4\u201324.7); P\u2009=\u20090.013, respectively].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The conservative approach was successful for 63% of the patients. We identified risk factors associated with the strategy\u2019s failure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivab123","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T11:42:38Z","timestamp":1617968558000},"page":"597-604","source":"Crossref","is-referenced-by-count":10,"title":["Outcome analysis of a conservative approach to diaphragmatic paralysis following congenital cardiac surgery in neonates and infants: a bicentric retrospective study"],"prefix":"10.1093","volume":"33","author":[{"given":"Sophie","family":"Denamur","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Pediatric Pneumology, University Hospital, Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4200-4838","authenticated-orcid":false,"given":"Alexis","family":"Chenouard","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8938-7544","authenticated-orcid":false,"given":"Bruno","family":"Lefort","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, University Hospital, Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8656-7152","authenticated-orcid":false,"given":"Olivier","family":"Baron","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Neville","sequence":"additional","affiliation":[{"name":"Department of Congenital Cardiac Surgery, University Hospital, Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2548-7858","authenticated-orcid":false,"given":"Alban","family":"Baruteau","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Joram","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Chantreuil","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital, Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7713-8153","authenticated-orcid":false,"given":"Pierre","family":"Bourgoin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France"},{"name":"Department of Anesthesiology, University Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"key":"2022030915261360900_ivab123-B1","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1002\/ppul.24383","article-title":"Diaphragmatic paralysis in young children: a literature review","volume":"54","author":"Gerard-Castaing","year":"2019","journal-title":"Pediatr Pulmonol"},{"key":"2022030915261360900_ivab123-B2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ejcts.2004.10.002","article-title":"Incidence and treatment of 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