One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study. Issue 6 (November 2019)

• Record Type: Journal Article
• Authors: Long, Anna-May; Bunch, Kathryn J; Knight, Marian; Kurinczuk, Jennifer J; Losty, Paul Damian
• Other Names: author non-byline.; S Marven author non-byline.; E Draper author non-byline.; P Johnson author non-byline.; P Brocklehurst author non-byline.; D Howe author non-byline.; J Rankin author non-byline.; A Aslam author non-byline.; W Jawaid author non-byline.; D Wilkinson author non-byline.; A Robb author non-byline.; A Lander author non-byline.; T Burki author non-byline.; L Coates author non-byline.; E Cusick author non-byline.; J Fishman author non-byline.; N Madden author non-byline.; B Adikibi author non-byline.; G Mackinlay author non-byline.; A Sabharwal author non-byline.; C Larcombe author non-byline.; J Curry author non-byline.; S Besarovic author non-byline.; K Ashour author non-byline.; P Johnson author non-byline.; H Carnaghan author non-byline.; M Davenport author non-byline.; I Sugarman author non-byline.; S Nour author non-byline.; T Tsang author non-byline.; A Paul author non-byline.; B Davies author non-byline.; D Mclaughlin author non-byline.; P Puri author non-byline.; R Abel author non-byline.; C Driver author non-byline.; A Mahomed author non-byline.; E Ervine author non-byline.; W Mccallion author non-byline.; S Phelps author non-byline.; R Craigie author non-byline.; A Morabito author non-byline.; Hunt M De La author non-byline.; G Hosie author non-byline.; K Lloyd author non-byline.; R Taylor author non-byline.; M Drewett author non-byline.; B Okoye author non-byline.; C Richards author non-byline.; J King author non-byline.; L P Nellihala author non-byline.; Hunt M de La author non-byline.; S Huddart author non-byline.;
• Is Part Of: Archives of disease in childhood. Volume 104:Issue 6(2019)
• Page Start: F643
• Publication Date: 2019-11
• Subjects: congenital diaphragmatic hernia -- mortality -- outcomes research -- prognosis -- congenital abnorm; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2018-316396
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objective: To report outcomes to 1 year, in infants born with congenital diaphragmatic hernia (CDH), explore factors associated with infant mortality and examine the relationship between surgical techniques and postoperative morbidity. Design: Prospective national population cohort study. Setting: Paediatric surgical centres in the UK and Ireland. Method: Data were collected to 1 year for infants with CDH live-born between 1 April 2009 to 30 September 2010. Factors associated with infant mortality are explored using logistic regression. Postoperative morbidity following patch versus primary closure, minimally invasive versus open surgery and biological versus synthetic patch material is described. Data are presented as n (%) and median (IQR). Results: Overall known survival to 1 year was 75%, 95% CI 68% to 81% (138/184) and postoperative survival 93%, 95% CI 88% to 97% (138/148). Female sex, antenatal diagnosis, use of vasodilators or inotropes, being small for gestational age, patch repair and use of surfactant were all associated with infant death. Infants undergoing patch repair had a high incidence of postoperative chylothorax (11/54 vs 2/96 in infants undergoing primary closure) and a long length of hospital stay (41 days, IQR 24–68 vs 16 days, IQR 10–25 in primary closure group). Infants managed with synthetic patch material had a high incidence of chylothorax (11/34 vs 0/19 with biological patch). Conclusion: The majority of infant deaths in babies born with CDH occur before surgical correction. Female sex, being born small for gestational age, surfactant use, patch repair and receipt of cardiovascular support were associated with a higher risk of death. The optimum surgical approach, timing of operation and choice of patch material to achieve lowest morbidity warrants further evaluation.