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Published on: February 5, 2021
[Prognostic factors and survival in neonates with congenital diaphragmatic hernia]
Luis R Longo dos Santos1, João G Maksoud-Filho, Uenis Tannuri
1Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. luisrls@icr.hcnet.usp.br
Insights
Congenital diaphragmatic hernia (CDH) survival in newborns is 56%, with severe respiratory distress and hypoxemia predicting poor outcomes. Extracorporeal membrane oxygenation may improve survival for non-responsive cases.
Area of Science:
- Pediatric Surgery
- Neonatology
- Medical Research
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition affecting newborns.
- Accurate prognostic factors are crucial for managing CDH and counseling families.
- Previous studies highlight the need for updated survival data and treatment strategies.
Purpose of the Study:
- To determine prognostic factors for neonatal survival in congenital diaphragmatic hernia (CDH) patients.
- To compare survival outcomes with international medical literature.
- To inform clinical management and family counseling regarding CDH.
Main Methods:
- A retrospective study of 27 newborns with congenital diaphragmatic hernia (CDH) was conducted.
- Data were collected from April 1991 to January 2002 at a major university hospital.
- Statistical comparisons were made with existing medical literature meta-analysis data.
Main Results:
- Overall neonatal survival for CDH was 56% (15/27).
- Severe respiratory distress, early mechanical ventilation, and severe hypoxemia were significant predictors of poor outcomes.
- Survival rates differed between infants born at the institution (33%) and transferred infants (73%).
Conclusions:
- The high mortality rate for congenital diaphragmatic hernia (CDH) in this study aligns with international findings.
- Extracorporeal membrane oxygenation (ECMO) may reduce mortality in refractory CDH cases.
- Family counseling for CDH can be guided by current global medical literature standards.
Objective:
To evaluate the prognostic factors importance to survival in neonatal period of newborns with congenital diaphragmatic hernia treated at Hospital das Clínicas, School of Medicine of Universidade de São Paulo, and to compare the outcome with data published in medical literature. So that the results of this study might allow updating family counseling and guiding changes in clinical management of our department.
Methods:
Retrospective study of 27 consecutive newborns with congenital diaphragmatic hernia admitted to the Pediatric Surgery Department of Instituto da Criança, School of Medicine of Universidade de São Paulo, from April 1991 to January 2002, and statistical comparison with medical literature metanalysis data.
Results:
Of 27 patients, 15 were born at our institution and 12 were admitted by transference after birth. Twelve (44%) have had congenital diaphragmatic hernia diagnosed prenatally and 23 (85%) were full-term newborns. Most patients presented early respiratory distress and needed intubation at delivery room. Six newborns presented criteria for indication of extracorporeal membrane oxygenation. Twenty patients (74%) were submitted to operative repair and seven (26%) died without the minimal clinical stabilization necessary for surgical procedure (five of these patients reached criteria for indication of extracorporeal membrane oxygenation). The postoperative mortality was 25% (5/20). The overall survival of neonatal period was 56% (15/27). The survival of patients that were born at our hospital was 33% (4/12), and the survival of the newborns admitted by transference was 73% (11/15). Severe respiratory distress, early indication to mechanical ventilation and severe hypoxemia (post-ductal pO2 < 100 mmHg despite all efforts) were identified as predictors of bad outcome with statistical significance.
Conclusion:
Our high mortality rate of newborns with congenital diaphragmatic hernia is statistically similar to that described in international publications. In the group of non-responsive patients to standard treatment available, the use of extracorporeal membrane oxygenation should be able to reduce mortality. The impact of this therapeutical strategy in the overall survival depends on other factors that were not analyzed in the present study. Family counseling of patients' parents on congenital diaphragmatic hernia in our department may follow the same patterns referred in world medical literature.
