Survival trends and outcomes among preterm infants with congenital diaphragmatic hernia

Peluso, Allison M; Othman, Hasan F.; Elsamny, Esraa; Sammour, Ibrahim; Yeaney, Natalie; Aly, Hany

doi:10.1038/s41372-019-0523-6

Cited by 21 publications

(25 citation statements)

References 15 publications

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“…Our overall mortality is comparable to internationally reported rates (20-40%), but after excluding confirmed genetic anomalies, the mortality was even lower, which is comparable to reports from many high-volume centers [42]. The mortality in preterm infants was double of that seen in term infants, consistent with previous studies reporting similar lower survival rates in preterm infants with CDH [43]. Post-surgical and post-ECMO mortality was also comparable to the CDHSG mortality rate of 14% after surgery [44] and was influenced by several factors, including the timing of surgery and pre-op stability [45,46].…”

Section: Discussionsupporting

confidence: 90%

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

Soni

Chakkarapani

et al. 2022

Pediatr Cardiol

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Ventricular dysfunction may be found in 40% of newborns with CDH, and is not only a predictor of disease severity, but also mortality and need for ECMO. We conducted this study to assess the utility of serial echocardiography in management of newborns with CDH and their survival outcomes. This is a retrospective study, wherein the demographic, clinical and echocardiographic data from our local CDH registry and hospital clinical database were analyzed to study the correlation of timed echocardiographic findings with mortality and other outcomes. Fourty-two newborns with CDH were admitted during the study period (M/F:19/23), with median gestation of 38 weeks (IQR:36–39) and birth weight of 2.83 kg (IQR 2.45–3.17). Thirty-one were left-sided, seven right, one central, and three bilateral hernias. Twelve infants (28%) died in early infancy. Three infants were excluded from analysis due to either palliation at birth or significant cardiac anomaly. A total of 137 echos from 39 infants were analyzed. Seventy percent of newborns who died and had an echo within the first 72 h, were noted to have suffered from moderate to severe PH. Birth weight < 2.8 kg, RVSP > 45.5 in the first 72 h and postoperative VIS > 23.5 and RSS > 4.3 were good predictors of mortality. Markers of elevated pulmonary pressures and cardiac function were useful in guiding therapy. Serial timed functional echocardiography (f-Echo) monitoring allows targeted therapy of patients with CDH. Birth weight, initial severity of pulmonary hypertension and postoperative RSS and VIS may be useful in predicting mortality.

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Section: Discussionsupporting

confidence: 90%

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

Soni

Chakkarapani

et al. 2022

Pediatr Cardiol

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“…This was similar to the rate that was discovered in this study (cases: 34.8% versus controls: 15.6%; p<0.001). According to Peluso et al (2020), the overall survival rate of children was as low as 49% with a survival range of 21.2% for gestational age <26 weeks and 62.3% for 35-36 weeks, respectively (Peluso et al, 2020). Birth weight less than 2500 grams was associated with increased odds of CDH (36.7% vs 12.6%; p<0.001, OR, 3.32; 95% CI, 1.65-5.89).…”

Section: Resultsmentioning

confidence: 99%

Predictors of congenital diaphragmatic hernia in newborns

Ahmedov¹,

Akhmedov²,

Fayzullayev³

et al. 2022

ijhs

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Congenital diaphragmatic hernia (CDH) is a disorder that is defined by a rupture of the diaphragm, which permits an abdominal hernia to enter the chest space. This disease may be present from birth. Our objective was to identify the features of a person that placed them at a higher risk for developing CDH. A case control study design was used to collect data from the registry for 66 people who had been diagnosed with CDH. The data were acquired from the registry. CDH infants were more likely to be preterm (OR, 3.79; 95 percent CI, 2.01-7.21) and weigh lower than 2500 gr at birth (OR, 3.32; 95 percent CI, 1.65-5.89). Maternal age of 35 years or older (OR, 3.51; 95 % CI, 1.49-6.12) and being small for gestational age (OR, 3.71; 95 % CI, 1.87-6.69) were associated with increased odds of having a CDH infant. Being preterm and small for gestational age as well as low birth weight were independent risk factors for congenital diaphragmal hernia. The chance of having a child born with CDH rises with the mother's age.

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“…Our matching design is also a limitation since it was not a randomized controlled trial, and fetuses were not individually matched according to other potential variables that may affect neonatal survival such as the rate of polyhydramnios, intrathoracic liver herniation or GA at birth. Taking into account that the lower the GA at birth, higher the risk of neonatal death, 23 the rate of preterm delivery in our control group (38%) may bias the results. We recognize that duration of tracheal occlusion within our FETO group was very broad (1–6 weeks), which may also affect the results.…”

Section: Discussionmentioning

confidence: 99%

Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia

Cruz‐Martínez

Shazly²,

Martínez‐Rodríguez³

et al. 2021

Prenatal Diagnosis

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Objective: To assess the effect of Fetal Endoscopic Tracheal Occlusion (FETO) on neonatal survival in fetuses with left congenital diaphragmatic hernia (CDH) and moderate lung hypoplasia.Study Design: CDH fetuses with moderate pulmonary hypoplasia (observed/ expected lung area to head ratio between 26% and 35%, or between 36% and 45% with liver herniation) were prospectively recruited. Included patients were matched to a control group who were ineligible for FETO. Primary outcomes were survival at 28 days, at discharge, and at 6 months of age, respectively.Results: 58 cases were recruited, 29 treated with FETO and 29 matched controls.Median gestational age (GA) at balloon placement and removal were 29.6 and 33.6 weeks, respectively. FETO group showed significantly lower GA at delivery (35.2 vs. 37.1 weeks, respectively, p < 0.01), higher survival at 28 days (51.7 vs. 24.1%, respectively, p = 0.03), at discharge (48.3 vs. 24.1%, respectively, p = 0.06), and at six months of age (41.4 vs. 24.1%, respectively, p = 0.16), and significantly lower length of ventilatory support (17.8 vs. 32.3 days, p = 0.01) and NICU stay (34.2 vs. 58.3 days, p = <0.01) compared to controls. Conclusion:FETO was associated with a non-significant increase in survival and significantly lower neonatal respiratory morbidity among CDH fetuses with moderate lung hypoplasia. Key PointsWhat's already known about this topic? � Fetal endoscopic tracheal occlusion (FETO) has shown an improvement on neonatal survival in fetuses with severe lung hypoplasia.� Fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia, that is those with O/E-LHR between 26% and 35% or between 36% and 45% and liver herniation, are associated with survival rates around 50%.

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Survival trends and outcomes among preterm infants with congenital diaphragmatic hernia

Cited by 21 publications

References 15 publications

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

Predictors of congenital diaphragmatic hernia in newborns

Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia

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