J Pediatr Surg. 2019 Oct 26. pii: S0022-3468(19)30698-0. doi: 10.1016/j.jpedsurg.2019.09.046. [Epub ahead of print]
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.
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).
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.
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.
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.
Congenital diaphragmatic hernia; Critical care; ECMO; ThoracicPMID: 31677822 DOI: 10.1016/j.jpedsurg.2019.09.046