Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: A retrospective cohort study
Document Type
Article
Publication Date
7-1-2022
Abstract
Background: Most studies examining survival of neonates with congenital diaphragmatic hernia (CDH) are in high-income countries. We aimed to describe the management, survival to hospital discharge rate, and factors associated with survival of neonates with unilateral CDH in a middle-income country. Methods: We retrospectively reviewed the medical notes of neonates with unilateral CDH admitted to a pediatric intensive care unit (PICU) in a tertiary referral center over a 15-year period, from 2003-2017. We described the newborns' respiratory care pathways and then compared baseline demographic, hemodynamic, and respiratory indicators between survivors and non-survivors. The primary outcome measure was survival to hospital discharge. Results: Altogether, 120 neonates were included with 43.3% (52/120) diagnosed antenatally. Stabilization occurred in 38.3% (46/120) with conventional ventilation, 13.3% (16/120) with high-frequency intermittent positive-pressure ventilation, and 22.5% (27/120) with high frequency oscillatory ventilation. Surgical repair was possible in 75.0% (90/120). The overall 30-day survival was 70.8% (85/120) and survival to hospital discharge was 66.7% (80/120). Survival to hospital discharge tended to improve over time (p> 0.05), from 56.0% to 69.5% before and after, respectively, a service reorganization. For those neonates who could be stabilized and operated on, 90.9% (80/88) survived to hospital discharge. The commonest post-operative complication was infection, occurring in 43.3%. The median survivor length of stay was 32.5 (interquartile range 18.8-58.0) days. Multiple logistic regression modelling showed vaginal delivery (odds ratio OR] = 4.8; 95% confidence interval CI] 1.1-21.67]; p= 0.041), Apgar score >= 7 at 5 min (OR= 6.7; 95% CI 1.2-36.3]; p = 0.028), and fraction of inspired oxygen (FiO(2)) <50% at 24 h (OR= 89.6; 95% CI 10.6-758.6]; p< 0.001) were significantly associated with improved survival to hospital discharge. Conclusions: We report a survival to hospital discharge rate of 66.7%. Survival tended to improve over time, reflecting a greater critical volume of cases and multi-disciplinary care with early involvement of the respiratory team resulting in improved transitioning from PICU. Vaginal delivery, Apgar score >= 7 at 5 min, and FiO(2) < 50% at 24 h increased the likelihood of survival to hospital discharge.
Keywords
Hernias, Diaphragmatic, Congenital, Infant, Newborn, Intensive care units, Pediatric, Prenatal diagnosis, Risk factors, Survival
Divisions
anaesthesiology,paediatrics,surgerydept
Funders
None
Publication Title
BMC Pediatrics
Volume
22
Issue
1
Publisher
BioMed Central
Publisher Location
CAMPUS, 4 CRINAN ST, LONDON N1 9XW, ENGLAND