Pulmonary support on Day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia☆,☆☆
Section snippets
Methods
We performed a retrospective cohort study of all patients in the CDH Study Group registry who had a hospital length of stay (LOS) ≥ 30 days during 2007–2010. IRB Approval was obtained from Boston Children's Hospital (IRB-P00002412). Thirty-three patients were missing 30-day pulmonary support status and therefore excluded. The primary outcome was mortality before hospital discharge. Secondary outcomes included need for a prolonged hospital stay (defined as a hospital stay longer than 60 days) and
Unadjusted analysis
862 CDH patients in the CDH study group registry had a LOS ≥ 30 days and had information regarding their need for pulmonary support. There were 320 patients on room air on hospital day 30 and 542 (62.9%) required some form of pulmonary support. Of those who required oxygen, 244 (45.0%) required only nasal cannula or CPAP, 279 (51.5%) needed some form of mechanical ventilation, and 19 (3.5%) were on ECMO support (Fig. 1). 30-day pulmonary support was associated with significant differences among
Discussion
We hypothesized that the degree of pulmonary support at 30 days could be used as a simple prognostic indicator for both late mortality and pulmonary morbidity in high-risk patients. We found that pulmonary support status at 30 days is the strongest independent predictor of both late mortality and pulmonary morbidity in survivors at discharge. This single factor can correctly predict over 85% of all subsequent inpatient deaths, and is a stronger independent predictor of mortality and discharge
Acknowledgments
This work was supported in part by Agency for Healthcare Research and Quality (AHRQ) Grant number T32HS019485 (RC), and National Institute of Child Health and Human Development (NICHD) Grant number K24HD060786 (JAF). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
References (24)
- et al.
Costs of congenital diaphragmatic hernia repair in the United States—extracorporeal membrane oxygenation foots the bill
J Pediatr Surg
(2011) - et al.
Long term respiratory outcomes of congenital diaphragmatic hernia, esophageal atresia, and cardiovascular anomalies
Semin Fetal Neonatal Med
(2012) - et al.
Surgical management of neonates with congenital diaphragmatic hernia
Semin Pediatr Surg
(2007) - et al.
Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network
J Pediatr Surg
(2011) - et al.
Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group
J Pediatr Surg
(2009) - et al.
Predictors of outcome in patients with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation
J Pediatr Surg
(2007) - et al.
Minimally invasive repair of congenital diaphragmatic hernia
J Pediatr Surg
(2011) - et al.
Influence of congenital heart disease on survival in children with congenital diaphragmatic hernia
J Pediatr
(2002) - et al.
Congenital diaphragmatic hernia: a simplified postnatal predictor of outcome
J Pediatr Surg
(2007) - et al.
Mortality prediction in congenital diaphragmatic hernia
J Pediatr Surg
(2008)
Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic
J Pediatr Surg
The use of extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia
Semin Perinatol
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2019, Journal of Pediatric SurgeryCitation Excerpt :Moreover, we also failed to identify any correlation between imaging parameters and the CDHSG equation for survival prediction [17,18]. Irrespective of the fact that we could not find similar correlations, there may be an opportunity to refine current prediction models by including pulmonary morbidity markers [8,29,31,32]. The primary goal of this quality improvement initiative (QI) was to better inform prenatal counseling at our respective centers.
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Bilateral congenital diaphragmatic hernia: prognostic evaluation of a large international cohort
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Author Contributions: All authors contributed to the study design, data collection, study analysis and the drafting of this article.
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Funding/Disclosure: None of the authors have commercial associations to disclose.