Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Lally KP, Lally PA, Lasky RE et al (2007) Defect size determines survival in infants with congenital diaphragmatic hernia. Pediatrics 120:e651–e657

    Article  PubMed  Google Scholar 

  3. 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

  4. 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 35:609–614

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Google Scholar 

  6. 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–e1006

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. 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 24:376–381

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 349:1916–1924

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 44:1691–1701

    Article  PubMed  Google Scholar 

  14. Hirschl RB (2004) Current experience with liquid ventilation. Paediatr Respir Rev 5 Suppl A:S339–S345

    Article  PubMed  Google Scholar 

  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 45:49–55

    PubMed  CAS  Google Scholar 

  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 37:1188–1190

    Article  PubMed  Google Scholar 

  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:F467

    Article  PubMed  CAS  Google Scholar 

  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 30:112–120

    Article  PubMed  Google Scholar 

  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 246:553–561

    Article  PubMed  Google Scholar 

  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 23:258–262

    Article  PubMed  Google Scholar 

  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 40:1827–1832

    Article  PubMed  Google Scholar 

  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 14:8–13

    Article  PubMed  Google Scholar 

  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

    Google Scholar 

  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)

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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 23:10062–10069

    PubMed  CAS  Google Scholar 

  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 13:550–552

    Article  PubMed  CAS  Google Scholar 

  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 103:278–282

    Article  PubMed  CAS  Google Scholar 

  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 24:667–670

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Canadian Institutes of Health Research (MOP 69050). CAPSNet also wishes to acknowledge the Ontario Ministry of Health and Long-Term Care and the CIHR Team in Maternal Infant Care for their financial and infrastructural support.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to M. E. Brindle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brindle, M.E., Brar, M., Skarsgard, E.D. et al. Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia. Pediatr Surg Int 27, 969–974 (2011). https://doi.org/10.1007/s00383-011-2925-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-011-2925-1

Keywords

Navigation