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Risk factors for mortality in infants with congenital diaphragmatic hernia: a single center experience
Jennifer Bettina Brandt1, Tobias Werther2, Erika Groth3
1Comprehensive Centre for Paediatrics, Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. jennifer.brandt@meduniwien.ac.at.
Insights
Infants with congenital diaphragmatic hernia have an 84.6% survival rate. Right-sided hernias and prolonged use of extracorporeal membrane oxygenation (ECMO) or inhaled nitric oxide (iNO) increase mortality risk.
Area of Science:
- Pediatric Surgery
- Neonatology
- Medical Research
Background:
- Congenital diaphragmatic hernia (CDH) management is complex, necessitating multidisciplinary care.
- Despite advancements, identifying mortality risk factors in CDH remains crucial.
Purpose of the Study:
- To investigate potential risk factors associated with mortality in infants diagnosed with congenital diaphragmatic hernia.
- To compare patient parameters between survivors and non-survivors of CDH.
Main Methods:
- A 16-year retrospective chart review of CDH patients at a single center.
- Analysis included comparison of medical data between survivors and non-survivors.
- Literature review to contextualize findings.
Main Results:
- Overall survival for CDH was 84.6% in the cohort of 66 patients.
- Right-sided CDH had significantly higher mortality (33.3%) compared to left-sided (7.8%).
- Prolonged venoarterial extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide (iNO) were identified as significant mortality risk factors.
Conclusions:
- The observed survival rate for CDH is consistent with current literature.
- The side of the diaphragmatic defect, duration of ECMO, and iNO treatment are key mortality risk factors.
- This study provides insights into CDH mortality, aiding future clinical trial design and patient management.
Background:
Despite current progress in research of congenital diaphragmatic hernia, its management remains challenging, requiring an interdisciplinary team for optimal treatment.
Objective:
Aim of the present study was to evaluate potential risk factors for mortality of infants with congenital diaphragmatic hernia.
Methods:
A single-center chart review of all patients treated with congenital diaphragmatic hernia over a period of 16 years, at the Medical University of Vienna, was performed. A comparison of medical parameters between survivors and non-survivors, as well as to published literature was conducted.
Results:
During the observational period 66 patients were diagnosed with congenital diaphragmatic hernia. Overall survival was 84.6%. Left-sided hernia occurred in 51 patients (78.5%) with a mortality of 7.8%. In comparison, right-sided hernia occurred less frequently (n = 12) but showed a higher mortality (33.3%, p = 0.000). Critically instable patients were provided with venoarterial extracorporeal membrane oxygenation (ECMO, 32.3%, n = 21). Survival rate among these patients was 66.7%. Right-sided hernia, treatment with inhaled nitric oxide (iNO) over 15 days and the use of ECMO over 10 days were significant risk factors for mortality.
Conclusion:
The survival rate in this cohort is comparable to the current literature. Parameters such as the side of the diaphragmatic defect, duration of ECMO and inhaled nitric oxide were assessed as mortality risk factors. This analysis of patients with congenital diaphragmatic hernia enhances understanding of risk factors for mortality, helping to improve management and enabling further evaluation in prospective clinical trials.
