Top

Pediatric Surgery International

Published in:

01-09-2011 | Original Article

Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia

Authors: M. E. Brindle, M. Brar, E. D. Skarsgard, and the Canadian Pediatric Surgery Network (CAPSNet)

Published in: Pediatric Surgery International | Issue 9/2011

Abstract

Background

Infants with congenital diaphragmatic hernia (CDH) have variable outcomes. There is a considerable potential benefit in being able to predict perinatally, which infants have severe hypoplasia and are thus more likely to die or survive with significant morbidity. We examine the relationship between a need for patch repair of CDH (PR) and outcome, using a national database.

Methods

Baseline characteristics of patients undergoing PR or non-patch repair (NPR) were compared. Multivariate analysis was performed to determine the association of PR with mortality and morbidity independent of other known predictors.

Results

Baseline characteristics of PR and NPR infants were similar although those infants with PR had higher SNAP-II scores. PR was an independent predictor of mortality with an odds ratio of 17.1 (95%CI 2.0–149.2) and was independently associated with secondary outcome measures of morbidity, including the need for oxygen at discharge and the duration of ventilation.

Conclusions

Infants requiring PR have significantly higher mortality and suffer greater morbidity than those undergoing NPR. This association is independent of other known predictors of mortality. Identifying prenatal features associated with this high risk group would be of great clinical value.

Tsao K, Lally KP (2008) The Congenital Diaphragmatic Hernia Study Group: a voluntary international registry. Semin Pediatr Surg 17:90–97PubMedCrossRef

Lally KP, Lally PA, Lasky RE et al (2007) Defect size determines survival in infants with congenital diaphragmatic hernia. Pediatrics 120:e651–e657PubMedCrossRef

Kitano Y, Okuyama H, Saito M et al (2010) Reevaluation of stomach position as a simple prognostic factor in fetal left congenital diaphragmatic hernia: a multicenter survey in Japan. Ultrasound Obstet Gynecol

Mullassery D, Ba’ath ME, Jesudason EC, Losty PD (2010) Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 35:609–614PubMedCrossRef

Hedrick HL, Danzer E, Merchant A et al (2007) Liver position and lung-to-head ratio for prediction of extracorporeal membrane oxygenation and survival in isolated left congenital diaphragmatic hernia. Am J Obstet Gynecol 197 (422):e421–e424

Dammann O, Shah B, Naples M et al (2009) Interinstitutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants. Pediatrics 124:e1001–e1006PubMedCrossRef

Richardson DK, Corcoran JD, Escobar GJ, Lee SK (2001) SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 138:92–100PubMedCrossRef

Skarsgard ED, MacNab YC, Qiu Z, Little R, Lee SK (2005) SNAP-II predicts mortality among infants with congenital diaphragmatic hernia. J Perinatol 25:315–319PubMedCrossRef

Kumar D, Super DM, Fajardo RA et al (2004) Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 hours of admission. J Perinatol 24:376–381PubMedCrossRef

10.

Jani JC, Nicolaides KH, Gratacos E et al (2009) Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 34:304–310PubMedCrossRef

11.

Harrison MR, Keller RL, Hawgood SB et al (2003) A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med 349:1916–1924PubMedCrossRef

12.

Khan AM, Lally KP (2005) The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia. Semin Perinatol 29:118–122PubMedCrossRef

13.

Guner YS, Khemani RG, Qureshi FG et al (2009) Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. J Pediatr Surg 44:1691–1701PubMedCrossRef

14.

Hirschl RB (2004) Current experience with liquid ventilation. Paediatr Respir Rev 5 Suppl A:S339–S345PubMedCrossRef

15.

Hwang SJ, Lee KH, Hwang JH et al (2004) Factors affecting the response to inhaled nitric oxide therapy in persistent pulmonary hypertension of the newborn infants. Yonsei Med J 45:49–55PubMed

16.

Okuyama H, Kubota A, Oue T et al (2002) Inhaled nitric oxide with early surgery improves the outcome of antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 37:1188–1190PubMedCrossRef

17.

Finer NN, Barrington KJ (2001) Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev CD000399

18.

Hunter L, Richens T, Davis C, Walker G, Simpson JH (2009) Sildenafil use in congenital diaphragmatic hernia. Arch Dis Child Fetal Neonatal Ed 94:F467PubMedCrossRef

19.

Nishie A, Tajima T, Asayama Y et al (2009) MR prediction of postnatal outcomes in left-sided congenital diaphragmatic hernia using right lung signal intensity: comparison with that using right lung volume. J Magn Reson Imaging 30:112–120PubMedCrossRef

20.

Busing KA, Kilian AK, Schaible T et al (2008) Reliability and validity of MR image lung volume measurement in fetuses with congenital diaphragmatic hernia and in vitro lung models. Radiology 246:553–561PubMedCrossRef

21.

Kunisaki SM, Barnewolt CE, Estroff JA et al (2008) Liver position is a prenatal predictive factor of prosthetic repair in congenital diaphragmatic hernia. Fetal Diagn Ther 23:258–262PubMedCrossRef

22.

Kitano Y, Nakagawa S, Kuroda T et al (2005) Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy. J Pediatr Surg 40:1827–1832PubMedCrossRef

23.

Deprest JA, Flemmer AW, Gratacos E, Nicolaides K (2009) Antenatal prediction of lung volume and in utero treatment by fetal endoscopic tracheal occlusion in severe isolated congenital diaphragmatic hernia. Semin Fetal Neonatal Med 14:8–13PubMedCrossRef

24.

Yang SH, Nobuhara KK, Keller RL et al (2007) Reliability of the lung-to-head ratio as a predictor of outcome in fetuses with isolated left congenital diaphragmatic hernia at gestation outside 24–26 weeks. Am J Obstet Gynecol 197:30.e1–30.e37

25.

Bretelle F, Mazouni C, D’Ercole C et al (2007) Fetal lung-head ratio measurement in the evaluation of congenital diaphragmatic hernia. J Pediatr Surg 42:1312–1313 (author reply 1313–1314)PubMedCrossRef

26.

Schultz CM, DiGeronimo RJ, Yoder BA (2007) Congenital diaphragmatic hernia: a simplified postnatal predictor of outcome. J Pediatr Surg 42:510–516PubMedCrossRef

27.

Baird R, MacNab YC, Skarsgard ED (2008) Mortality prediction in congenital diaphragmatic hernia. J Pediatr Surg 43:783–787PubMedCrossRef

28.

Casaccia G, Crescenzi F, Dotta A et al (2006) Birth weight and McGoon Index predict mortality in newborn infants with congenital diaphragmatic hernia. J Pediatr Surg; 41:25–28 (discussion 25–28)PubMedCrossRef

29.

Graziano JN (2005) Cardiac anomalies in patients with congenital diaphragmatic hernia and their prognosis: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 40:1045–1049 (discussion 1049–1050)PubMedCrossRef

30.

Thebaud B, Azancot A, de Lagausie P et al (1997) Congenital diaphragmatic hernia: antenatal prognostic factors. Does cardiac ventricular disproportion in utero predict outcome and pulmonary hypoplasia? Intensive Care Med 23:10062–10069PubMed

31.

Hilfiker ML, Karamanoukian HL, Hudak M, Fisher J, Glick PL (1998) Congenital diaphragmatic hernia and chromosomal abnormalities: report of a lethal association. Pediatr Surg Int 13:550–552PubMedCrossRef

32.

Witters I, Legius E, Moerman P et al (2001) Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphragmatic hernia. Am J Med Genet 103:278–282PubMedCrossRef

33.

Zamakhshary M, Mah K, Mah D et al (2008) Physiologic predictors for the need for patch closure in neonatal congenital diaphragmatic hernia. Pediatr Surg Int 24:667–670PubMedCrossRef

Title: Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia
Authors: M. E. Brindle
M. Brar
E. D. Skarsgard
and the Canadian Pediatric Surgery Network (CAPSNet)
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 9/2011
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-011-2925-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2011

Oral maxillofacial tumors and tumor-like conditions: a Ugandan survey

The impact of early sonographic evaluation on hospital admissions of children with suspected acute appendicitis

Contralateral C7 transfer for the treatment of upper obstetrical brachial plexus palsy

Laparoscopic single port surgery in children using Triport: our early experience

Placement of prophylactic drains after laparotomy may increase infectious complications in neonates

Does propofol prevent testicular ischemia–reperfusion injury due to torsion in the long term?