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Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery. J Pediatr Surg 2004 Jun;39(6):821-4; discussion 821-4

Date

06/09/2004

Pubmed ID

15185204

DOI

10.1016/j.jpedsurg.2004.02.010

Scopus ID

2-s2.0-3042677384 (requires institutional sign-in at Scopus site)   69 Citations

Abstract

PURPOSE: Controversy persists regarding the factors influencing survival in patients with congenital diaphragmatic hernia (CDH), in particular, the role of timing of surgery. The authors therefore sought to determine such factors and to assess the relative role of timing of surgery on outcome.

METHODS: All CDH newborns 1991 through 2002 (n = 111) were divided into those undergoing repair before ("early" n = 35), or after ("late" n = 76) 48 hours. A multivariate analysis was performed to determine the relative impact of various factors on survival rate.

RESULTS: Overall survival rate was 64%. There was no effect on survival of heart rate, temperature, systolic blood pressure, age, extracorporeal membrane oxygenation use, mesh use, infections, or intracranial hemorrhage, and there was no difference between early (68%) or late (62%) repair (P =.2). Initial pCO2 greater than 50, pO2 less than 40, cardiac defects, or renal failure significantly decreased survival rate.

CONCLUSIONS: Significant factors influencing survival rate in patients with CDH include cardiac defects, renal failure, and the initial blood gases and not the timing of surgery. CDH repair should be based on the optimization of clinical parameters as opposed to a specific time period to improve outcome.

Author List

Rozmiarek AJ, Qureshi FG, Cassidy L, Ford HR, Hackam DJ

Author

Laura Cassidy PhD Associate Dean, Institute Director, Professor in the Institute for Health and Humanity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Abnormalities, Multiple
Acute Kidney Injury
Birth Weight
Carbon Dioxide
Extracorporeal Membrane Oxygenation
Female
Heart Defects, Congenital
Hernia, Diaphragmatic
Hernias, Diaphragmatic, Congenital
Humans
Hypercapnia
Infant, Newborn
Intracranial Hemorrhages
Male
Multivariate Analysis
Oxygen
Postoperative Complications
Retrospective Studies
Risk Factors
Surgical Mesh
Survival Analysis
Time Factors