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 2,280 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, pppp 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.