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Survival trends and outcomes among preterm infants with congenital diaphragmatic hernia
Allison M Peluso1, Hasan F Othman2, Esraa M Elsamny2
1Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA. pelusoa@ccf.org.
Insights
Survival rates for preterm infants with congenital diaphragmatic hernia (CDH) are low, but have improved over time. Lower gestational age significantly decreases survival chances for these infants.
Area of Science:
- Pediatric Surgery
- Neonatalogy
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect affecting lung development.
- Preterm birth is a significant risk factor for adverse outcomes in infants with CDH.
Purpose of the Study:
- To analyze national data on the characteristics and survival trends of preterm infants with CDH.
- To identify factors influencing survival in this vulnerable population.
Main Methods:
- Utilized data from the National Inpatient Sample (NIS) and KID database (2004-2014).
- Included infants diagnosed with CDH and gestational age < 37 weeks.
- Employed descriptive statistics, chi-square tests, and trend analysis.
Main Results:
- Identified 2356 preterm infants with CDH; overall survival rate was 49%.
- Survival rates varied significantly with gestational age, from 21.2% (<26 weeks) to 62.3% (35-36 weeks).
- Surgical repair was performed in 55.1% of cases; 89% of non-survivors did not undergo repair.
Conclusions:
- Preterm infants with CDH have substantially lower survival rates compared to term infants.
- Survival rates are inversely correlated with lower gestational age.
- Survival trends for CDH infants have shown improvement over the study period.
Objective:
The objective of this study was to use current national data to evaluate the characteristics and survival trends of preterm infants born with CDH from 2004 to 2014.
Study Design:
Data was queried from the National Inpatient Sample (NIS) and KID database from 2004 to 2014. Infants were included if diagnosed with CDH by ICD-9 coding and gestational age <37 weeks. Descriptive statistics, chi-square, and trend analysis were completed.
Results:
We identified 2356 infants born prematurely with CDH. The overall survival rate was 49%. The survival range is 21.2-62.3% for gestational age <26 weeks to 35-36 weeks, respectively. Total mortality was 1183; of them, 1052 (89%) were not repaired and 363 (30.7%) did not receive mechanical ventilation. Surgical repair occurred in 55.1% of infants.
Conclusions:
Preterm infants have lower survival compared with term infants. Survival rates decrease with lower gestational age and have improved over time.
