J Pediatr Surg. 2019 Oct 26. pii: S0022-3468(19)30698-0. doi: 10.1016/j.jpedsurg.2019.09.046. [Epub ahead of print]

https://www.ncbi.nlm.nih.gov/pubmed/31677822

Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia: A Multicenter Analysis.

Abramov A¹, Fan W², Hernan R³, Zenilman AL⁴, Wynn J³, Aspelund G⁴, Khlevner J³, Krishnan U³, Lim FY⁵, Mychaliska GB⁶, Warner BW⁷, Cusick R⁸, Crombleholme T⁵, Chung D⁹, Danko ME⁹, Wagner AJ¹⁰, Azarow K¹¹, Schindel D¹², Potoka D¹³, Soffer S¹⁴, Fisher J¹⁵, McCulley D¹⁶, Farkouh-Karoleski C³, Chung WK¹⁷, Duron V⁴.

Author information

Abstract

BACKGROUND:

Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500-3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH).

METHODS:

We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH.

RESULTS:

A total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p=0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p=0.022) and a higher frequency of need for oxygen at discharge (p=0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence.

CONCLUSION:

In this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair.

TYPE OF STUDY:

Prognosis study LEVEL OF EVIDENCE: Level II.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Congenital diaphragmatic hernia; Critical care; ECMO; ThoracicPMID: 31677822 DOI: 10.1016/j.jpedsurg.2019.09.046