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Congenital diaphragmatic hernia: relationship between defect size and outcome. Experience in a reference centre
Jesica Cecilia Otaño1, Victoria Murua1, Julieta Rugilo1
1Área de Cuidados Intensivos Neonatales, Área de Terapia Intensiva Neonatal, Hospital de Pediatria Juan P. Garrahan, Ciudad de Buenos Aires, Argentina.
Insights
Large congenital diaphragmatic hernia (CDH) defects (sizes C-D) significantly increase the risk of chronic pulmonary disease (CPD) and the need for extracorporeal membrane oxygenation in newborns. CDHSG staging aids in predicting patient outcomes and complications.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Thoracic Surgery
Background:
- Congenital diaphragmatic hernia (CDH) presents a significant therapeutic challenge in neonates.
- The Congenital Diaphragmatic Hernia Study Group (CDHSG) classification, based on defect size, is crucial for staging and predicting outcomes.
- Larger CDH defects are consistently linked to poorer patient prognoses.
Purpose of the Study:
- To describe and compare morbidity at hospital discharge for newborns undergoing CDH surgical correction.
- To evaluate morbidity based on the surgical staging of the defect as proposed by the CDHSG.
- To analyze the association between CDH defect size and patient outcomes.
Main Methods:
- Retrospective analysis of 230 CDH patients admitted between 2012 and 2020.
- Inclusion of 158 patients who underwent surgical correction for CDH.
- Descriptive, bivariate, and multivariate analyses to assess defect size, morbidity, and mortality.
Main Results:
- Defect sizes C and D were associated with increased risks of chronic pulmonary disease (CPD) (OR, 5.3) and need for extracorporeal membrane oxygenation (OR 3.9).
- Multivariate analysis confirmed large defect size (C-D) as an independent predictor of CPD (OR 4.19).
- Chylothorax also showed a higher incidence with larger defects (OR, 2.1), though not statistically significant in all analyses.
Conclusions:
- Surgical staging of CDH defects using the CDHSG classification enables standardized management.
- This classification system aids in predicting patient outcomes and potential complications during hospitalization.
- Accurate staging is vital for optimizing care and improving outcomes for neonates with CDH.
Introduction:
Congenital diaphragmatic hernia (CDH) remains a therapeutic challenge. The surgical classification recommended by the Congenital Diaphragmatic Hernia study group (CDHSG), based on the size of the defect, is used for staging in reference centres. Larger defects are associated with poorer outcomes. Our aim was to describe and compare the morbidity at hospital discharge of newborns who underwent surgical correction of CDH at the Juan P. Garrahan, according to the surgical staging of the defect proposed by the CDHSG.
Material And Methods:
The study included patients with CDH admitted to the Juan P. Garrahan Hospital between 2012 and 2020, and we analysed the distribution, morbidity and mortality associated with the size of the defect. We carried out a descriptive analysis, calculating measures of central tendency and dispersion, and bivariate and multivariate analyses.
Results:
A total of 230 patients with CDH were admitted and 158 underwent surgery. We found that defect sizes C and D sizes were associated with an increased risk of chronic pulmonary disease (CPD) (OR, 5.3; 95% CI, 2.2-13.4; P<.0000), need of extracorporeal membrane oxygenation (OR 3.9; 95% CI, 1.3-12.8; P<.005) and chylothorax (OR, 2.1; 95% CI, 0.8-6.4; P<.10]. The multivariate analysis revealed that a large defect size (C-D) was independently and significantly associated with CPD (OR 4.19; 95% CI, 1.76-9.95).
Conclusion:
Staging the defect according to de CDHSG classification during surgery allows the application of uniform management criteria and the prediction of patient outcomes and complications during the hospital stay.
