Related Experiment Video
Updated: Dec 29, 2025
Transuterine Fetal Tracheal Occlusion Model in Mice
Published on: February 5, 2021
Surgical Complications in Children with CDH: A Multivariate Analysis
Kim Heiwegen1, Iris A L M van Rooij2, Arno van Heijst3
1Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Kim.Heiwegen@radboudumc.nl.
Insights
Extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide increase hemorrhage risk in congenital diaphragmatic hernia (CDH) patients. Abdominal patch repair and pulmonary hypertension are linked to higher CDH recurrence rates.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Critical Care
Background:
- Congenital diaphragmatic hernia (CDH) treatments have improved survival rates but increased morbidity.
- Understanding treatment-specific complications is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the impact of various medical and surgical interventions on the incidence of surgical complications in CDH patients.
- To identify specific treatments associated with increased morbidity in CDH management.
Main Methods:
- Retrospective analysis of 197 surgically repaired CDH patients (2000-2015).
- Multivariate logistic regression to assess the independent effect of treatments on surgical outcomes.
- Adjustment for multiple risk factors to isolate treatment-specific complications.
Main Results:
- Sixty of 197 CDH patients experienced surgical complications.
- Hemorrhagic complications were significantly higher in the ECMO group (27% vs. 2%, p<0.001).
- Inhaled nitric oxide use was strongly associated with hemorrhage (OR=13.0). Chylothorax was not significantly linked to ECMO or patch repair. Recurrence was associated with pulmonary hypertension (OR=10.0) and abdominal patch use (OR=11.3).
Conclusions:
- ECMO and inhaled nitric oxide, while used for severe CDH, elevate the risk of surgical hemorrhage.
- Abdominal patch repair and pulmonary hypertension are independent risk factors for CDH recurrence.
- Further research should focus on mitigating these treatment-associated risks to improve long-term CDH patient outcomes.
Introduction:
Several medical and surgical improvements in the treatment of congenital diaphragmatic hernia (CDH) patients have led to a higher survival rate. However, some of these improvements also lead to an increased morbidity rate. This study aims to determine the contribution different medical and surgical treatments have had on the development of surgical complications.
Method:
All CDH patients treated in a single centre between 2000 and 2015 were retrospectively evaluated. Multivariate logistic regression was used to estimate the independent effects of several treatment options that could influence the surgical outcome by adjustment for multiple risk factors.
Results:
Sixty of the 197 surgically repaired CDH patients had surgical complications. There were more haemorrhagic complications in the ECMO compared to non-ECMO group (27% vs. 2%, p < 0.001). The use of inhaled nitric oxide was also significantly related to haemorrhage (OR = 13.0 (95% CI 1.1-159)). After adjustment for other risk factors, chylothorax was neither significantly associated with ECMO treatment (OR = 1.6 (95% CI 0.5-5.2) nor with patch repair (OR = 2.1: 95% CI 0.7-6.1). A recurrence occurred more often in patients with pulmonary hypertension (OR = 10.0 (95% CI 1.5-65.8) and after treatment with an abdominal patch (OR = 11.3: 95% CI 1.5-84.4).
Conclusion:
ECMO treatment and the inhalation of nitric oxide are used in the most severe CDH patients but are associated with a higher risk on surgical haemorrhage. The recurrence rate is associated with both the use of an abdominal patch and the presence of pulmonary hypertension, regardless of medical treatment.
