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Congenital Diaphragmatic Hernia Defect Size and Infant Morbidity at Discharge
Luke R Putnam1, Matthew T Harting2, Kuojen Tsao1
1McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas.
Insights
Infants with congenital diaphragmatic hernia (CDH) and larger defect sizes experience more significant pulmonary, neurologic, and gastrointestinal issues. Defect size is the most reliable predictor of a patient's hospital course and overall disease burden at discharge.
Area of Science:
- Pediatric Surgery
- Neonatology
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) survival has improved, but significant morbidity persists.
- Larger CDH defect sizes are linked to increased mortality, yet their association with morbidity is less understood.
Purpose of the Study:
- To investigate the relationship between CDH defect size and pulmonary, neurologic, and gastrointestinal morbidity at hospital discharge.
Main Methods:
- An international, prospective cohort study analyzed 3665 infants with CDH.
- Data included demographics, intraoperative defect size, and clinical outcomes.
- Morbidity at discharge was defined by oxygen requirement, neurologic findings, reflux, nutrition, or related medications.
Main Results:
- Overall survival was 70.9%; 84% of survivors were discharged.
- 74.2% of discharged infants had at least one morbidity (pulmonary, neurologic, or gastrointestinal).
- Defect size was the strongest predictor of overall morbidity, length of stay, and ventilation duration.
Conclusions:
- Infants with CDH frequently have multiple morbidities at discharge.
- Congenital diaphragmatic hernia defect size is the most reliable indicator of hospital course and discharge morbidity burden.
Background And Objective:
Survival for infants with congenital diaphragmatic hernia (CDH) has gradually improved, yet substantial burden of disease remains. Although larger CDH defect sizes increase mortality, the association between defect size and morbidity has not been reported. Our objective was to evaluate the association of defect size with pulmonary, neurologic, and gastrointestinal morbidity at the time of hospital discharge.
Methods:
An international, prospective cohort study was performed. Patient demographics, intraoperative defect size, and clinical outcomes were reviewed. The primary outcome was morbidity at the time of discharge, which entailed supplemental oxygen requirement, abnormal neurologic clinical and radiographic findings, gastroesophageal reflux, supplemental nutrition, or pulmonary-, neurologic-, or gastrointestinal-related medications.
Results:
A total of 3665 patients were included in the study cohort. Overall survival was 70.9%, and 84.0% of survivors were discharged from the hospital (16.0% transferred). Median age at discharge was 38 days (interquartile range [IQR] 23-69) and ranged from 22 (IQR 16-32) days for "A" (smallest) defects to 89 (IQR 64-132) days for "D" (largest) defects (P < .001). Of those discharged from the hospital, 1522 (74.2%) had pulmonary (n = 660, 30.2%), neurologic (n = 446, 20.4%), or gastrointestinal (n = 1348, 61.7%) morbidities, and multiple morbidities were diagnosed in 701 (34.7%) patients. On multivariable regression analyses incorporating key patient characteristics, defect size was consistently the greatest predictor of overall morbidity, hospital length of stay, and duration of ventilation.
Conclusions:
Infants with CDH are commonly discharged with ≥1 major morbidities. The size of the diaphragmatic defect appears to be the most reliable indicator of a patient's hospital course and discharge burden of disease.
