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Short-term outcomes and medical and surgical interventions in infants with congenital diaphragmatic hernia
Theresa R Grover1, Karna Murthy2, Beverly Brozanski3
1Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado.
Insights
Infants with congenital diaphragmatic hernia (CDH) face high mortality risks, especially premature infants. Treatment strategies and outcomes varied, with survivors experiencing fewer complications.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) is a severe condition affecting infant development.
- Understanding treatment patterns and outcomes is crucial for improving infant survival rates.
Purpose of the Study:
- To analyze medical and surgical treatments for infants with congenital diaphragmatic hernia (CDH).
- To evaluate the short-term outcomes and survival rates in a cohort of CDH infants.
Main Methods:
- Retrospective analysis of 572 infants with CDH from 2010-2013.
- Data collected from 27 children's hospitals via the Children's Hospital Neonatal Database (CHND).
- Infants stratified by gestational age, birth weight, and survival status.
Main Results:
- Overall mortality was 29%, significantly higher in preterm infants (50% vs. 26%).
- Mature infants (≥34 weeks gestation, ≥2 kg) had better outcomes, including shorter ventilation times and higher ECMO use.
- Nonsurvivors were more likely to have major congenital anomalies and receive advanced respiratory/circulatory support.
Conclusions:
- Infants with CDH, particularly preterm infants, have elevated morbidity and mortality risks.
- Treatment approaches for respiratory and circulatory support differed between survivors and nonsurvivors.
- This collaborative data registry enhances the understanding of short-term CDH outcomes.
Objective:
The aim of this study is to characterize medical and surgical therapies and short-term outcomes in infants with congenital diaphragmatic hernia (CDH).
Study Design:
Retrospective analysis of CDH infants admitted to 27 children's hospitals submitting data to Children's Hospital Neonatal Database (CHND) from 2010 to 2013, stratified by gestational age, birth weight, and survival.
Results:
A total of 572 infants were identified, 508 (89%) born ≥ 34 weeks' gestation and ≥ 2 kg. More mature infants had higher APGAR scores, shorter duration of mechanical ventilation, and were more likely to receive extracorporeal membrane oxygenation (ECMO). Overall, mortality for the cohort was 29%, with mortality lower in infants born ≥ 34 weeks' gestation and ≥ 2 kg (26 vs. 50%, p < 0.01). Nonsurvivors were more likely to receive treatment with high-frequency oscillatory ventilation (HFOV), vasopressors, pulmonary vasodilators, and ECMO, and to have associated major congenital anomalies than survivors. In hospital morbidity and complications were relatively uncommon among survivors.
Conclusion:
Infants with CDH have a high risk of morbidity and mortality, and for preterm infants with CDH those risks are amplified. Patterns of respiratory and circulatory support appeared to be different for survivors. In addition to established data registries, this consortium of regional neonatal intensive care units provides a new collaborative effort to describe short-term outcomes for infants referred with CDH.
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Assessment:
1. Clinical Evaluation:
History: