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Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility

Marnie Goodwin Wilson1, Alana Beres, Robert Baird

  • 1Divisions of Pediatric Surgery, The Montreal Children's Hospital, Montreal, QC, Canada.

Journal of Pediatric Surgery
|May 25, 2013
PubMed

Insights

Infants with congenital diaphragmatic hernia (CDH) who died without surgery were similar to those who received repair, based on illness severity and malformations. Developing criteria for surgical ineligibility is suggested.

Area of Science:

  • Pediatric Surgery
  • Neonatology
  • Congenital Anomalies

Background:

  • Congenital diaphragmatic hernia (CDH) is a serious condition requiring surgical intervention.
  • Limited data exists on liveborn CDH patients who do not undergo surgery.
  • Understanding characteristics of non-surgically treated CDH patients is crucial for care optimization.

Purpose of the Study:

  • To compare liveborn CDH patients who died without surgery to those who received surgical repair.
  • To identify factors differentiating these groups within a national cohort.

Main Methods:

  • Analysis of a national CDH database (2005-2009).
  • Identification of a potential surgical candidate (PSC) subgroup excluding infants with severe instability or malformations.
  • Comparison of PSCs with the operative group (OG) and operative non-survivor (ONS) subgroups.

Main Results:

  • Of 275 liveborns, 35 (13%) died without surgery.
  • The PSC subgroup (n=11) had a median survival of 10 days; most were treated in ECMO centers.
  • No significant differences in birth weight, gestational age, or minor malformations were found between PSC and OG.
  • Neonatal illness severity (SNAP-II) predicted mortality but was similar between PSC and ONS groups.

Conclusions:

  • Potential surgical candidates (PSCs) exhibited similar illness severity and malformation profiles to infants offered surgery.
  • Current criteria may not adequately distinguish between surgical candidates and those unlikely to benefit.
  • Standardized criteria for surgical ineligibility in CDH are recommended.
Abstract

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