J Pediatr Surg
. 2025 Sep 12:162643.
doi: 10.1016/j.jpedsurg.2025.162643. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/40946846/
Evaluation of timing of repair of congenital diaphragmatic hernia in premature infants
Yeu Sanz Wu 1, Alysala Malik 2, Ashley H Ebanks 3, Darina Kirilina 4, Paul Kurlansky 5, Usha S Krishnan 6, Vincent P Duron 7; Congenital Diaphragmatic Hernia Study Group
Affiliations Expand
- PMID: 40946846
- DOI: 10.1016/j.jpedsurg.2025.162643
Abstract
Purpose: Premature infants with congenital diaphragmatic hernia (CDH) require complex decision-making, including when to repair. This study aims to determine the optimal timing of repair in premature infants.
Methods: The CDH Study Group registry was queried from 2015 to 2024. Preterm neonates (<37 weeks gestational age (GA) at birth) who underwent repair were included. Cubic splines of GA at repair and survival probability were used to determine the cohorts. Differences between cohorts were assessed using Chi-square or Kruskal-Wallis tests, as applicable, and multivariable regression analyses.
Results: Of the 857 neonates studied, survival probability increased with increasing GA at repair until it plateaued at 31.8 weeks, at which point survival was equivalent to that of term neonates. Those repaired <32 weeks of GA were of lower birth weight 1.48 (IQR 0.5) vs. 2.40 (0.63) kg (p < 0.001) and of younger postmenstrual age at time of repair 30.3 (2) vs. 36.1 (1.7) weeks (p < 0.001). The two cohorts did not significantly differ in select physiologic indicators or severity of CDH. Those repaired at <32 weeks of GA had higher rates of abnormal head imaging (43.9 % vs. 24 %, p = 0.009). After adjusting for use of inhaled nitric oxide and need for extracorporeal membrane oxygenation, those repaired <32 weeks of GA had 68 % lower odds of survival (AOR 0.32 (96 % CI 0.15, 0.72), p = 0.004).
Conclusion: Our study is limited by its retrospective nature, but demonstrates an association between GA at repair and outcomes in premature infants. Prospective studies may better elucidate the effect of timing of repair on these outcomes.
Keywords: Congenital diaphragmatic hernia; Congenital diaphragmatic hernia study group; Extracorporeal membrane oxygenation; Gestational age; Prematurity; Survival; Timing of repair; Weight.
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