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: < 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.