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Congenital Diaphragmatic Hernia: Perinatal Prognostic Factors and Short-Term Outcomes in a Single-Center Series
Camilla Pagliara1, Elisa Zambaiti1,2, Giulia Brooks1
1Department of Pediatric Surgery, Universitary Hospital of Padova, 35128 Padova, Italy.
Insights
Congenital diaphragmatic hernia (CDH) outcomes are influenced by defect size and need for patch repair. Larger defects and patch repair correlate with longer hospital stays for newborns with CDH.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition affecting newborns.
- Established prognostic factors include diaphragmatic defect size, need for patch repair, pulmonary hypertension, and left ventricular dysfunction.
Purpose of the Study:
- To analyze the influence of known prognostic factors on CDH patient outcomes.
- To identify additional prognostic factors affecting CDH patient outcomes in a specific department.
Main Methods:
- Observational retrospective single-center study.
- Inclusion of all posterolateral CDH patients treated between 1997 and 2019.
- Evaluation of mortality and length of hospital stay using univariate and multivariate analysis.
Main Results:
- 140 CDH patients were analyzed; 34.8% mortality.
- Median length of stay was 24 days.
- Univariate analysis showed defect size, patch repair, and spleen-up impacted outcomes. Multivariate analysis linked patch repair and dopamine dose to length of stay.
Conclusions:
- Longer hospitalization for CDH newborns is associated with higher dopamine doses for left ventricular dysfunction.
- The need for patch repair in large diaphragmatic defects also prolongs hospital stay.
Abstract:
Background: Many prognostic factors for CDH patients are described and validated in the current literature: the size of diaphragmatic defects, need for patch repair, pulmonary hypertension and left ventricular dysfunction are recognized as the most influencing outcomes. The aim of this study is to analyze the influence of these parameters in the outcome of CDH patients in our department and identify any further prognostic factors. Methods: An observational retrospective single-center study was conducted including all patients treated at our centre with posterolateral CDH between 01.01.1997 and 12.31.2019. The main outcomes evaluated were mortality and length of hospital stay. A univariate and multivariate analysis was performed. Results: We identified 140 patients with posterolateral CDH; 34.8% died before discharge. The overall median length of stay was 24 days. A univariate analysis confirmed that both outcomes are associated with the size of diaphragmatic defects, need for patch repair and presence of spleen-up (p < 0.05). A multivariate analysis identified that the need for patch repair and maximum dopamine dose used for cardiac dysfunction are independent parameters associated with the length of stay only (p < 0.001). Conclusions: In our series, the duration of hospitalization is longer for newborns with CDH treated with higher doses of dopamine for left ventricular dysfunction or needing patch repair in large diaphragmatic defects.
