Right- versus left-sided congenital diaphragmatic hernia: a comparative outcomes analysis

Area of Science:

• Pediatric Surgery
• Neonatal Medicine
• Pulmonology

Background:

• Congenital diaphragmatic hernia (CDH) is a serious birth defect.
• Right-sided CDH (R-CDH) is less common than left-sided CDH but may have distinct characteristics.
• Standardized treatment and follow-up are crucial for managing CDH outcomes.

Purpose of the Study:

• To compare the clinical characteristics and treatment outcomes of patients with left-sided CDH versus right-sided CDH.
• To identify specific pulmonary morbidities associated with R-CDH.
• To evaluate the impact of defect laterality on patient management and prognosis.

Main Methods:

• Retrospective chart review of 330 CDH patients treated between 2002 and 2014.
• Analysis of categorical variables using Fisher's exact test.
• Analysis of continuous variables using Mann-Whitney t-test.

Main Results:

• Out of 330 CDH patients, 56 (17%) had R-CDH and 274 (83%) had left-sided CDH.
• R-CDH was associated with longer nitric oxide therapy, increased need for tracheostomy, and higher rates of supplemental oxygen at discharge.
• Patients with R-CDH experienced more chronic pulmonary hypertension requiring long-term Sildenafil therapy.

Conclusions:

• R-CDH is not associated with increased mortality but leads to greater pulmonary complications.
• Increased need for pulmonary vasodilatory therapy and tracheostomy highlights the severity of pulmonary hypoplasia in R-CDH.
• Delivery at tertiary centers with expertise in CDH management is recommended for R-CDH patients.