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Research: Risk factors associated with mortality in newborn infants with congenital diaphragmatic hernia.

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Research: Risk factors associated with mortality in newborn infants with congenital diaphragmatic hernia.

Arch Argent Pediatr. 2020 Jun;118(3):180-186. doi: 10.5546/aap.2020.eng.180. https://pmlegacy.ncbi.nlm.nih.gov/pubmed/32470253

Risk factors associated with mortality in newborn infants with congenital diaphragmatic hernia.

[Article in English, Spanish; Abstract available in Spanish from the publisher]Galletti MF1Giudice C2Brener Dik PH2Fernández Jonusas S2Baldini L2Mariani GL2.

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Abstract

in EnglishSpanish

INTRODUCTION:

Morbidity and mortality are high in congenital diaphragmatic hernia. Some tools help to predict survival, both prenatally (observed/expected lung-to-head ratio [OELHR], presence of the liver in the chest) and postnatally (Congenital Diaphragmatic Hernia Study Group [CDHSG] score). Our objective was to identify the risk factors associated with mortality and estimate the risk-adjusted mortality in the prenatal period in the subgroup of patients with isolated left-sided hernia.

POULATION AND METHODS:

Retrospective and analytical study of patients born at Hospital Italiano de Buenos Aires between 2011 and 2018. A multivariate analysis was done to assess mortality-associated risk factors. For riskadjusted mortality in the prenatal period, the ratio between the observed mortality and the mean “expected” mortality based on the OELHR was estimated.

RESULTS:

A total of 53 patients were included. Their median gestational age was 38 weeks, and their mean birth weight was 3054 g. Isolated hernia was observed in 73 % of patients. Overall mortality was 45 %, and higher in patients with associated malformations. In the multivariate analysis, the presence of severe pulmonary hypertension estimated by postnatal echocardiogram was independently associated with mortality (adjusted odds ratio: 6.4, 95 % confidence interval: 1.02-40). The observed overall mortality in patients with isolated left-sided hernia was similar to that expected (ratio: 1.05).

CONCLUSION:

Overall mortality was similar to that expected based on the OE-LHR. In our population, severe pulmonary hypertension after birth was a determining factor of mortality.

Sociedad Argentina de Pediatría.

KEYWORDS:

congenital diaphragmatic hernia; neonatal mortality; pulmonary hypertension; risk factorsPMID: 32470253 DOI: 10.5546/aap.2020.eng.180

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