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Research: In-Hospital Morbidities for Neonates With Congenital Diaphragmatic Hernia: The Impact of Defect Size and Laterality

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Research: In-Hospital Morbidities for Neonates With Congenital Diaphragmatic Hernia: The Impact of Defect Size and Laterality

J Pediatr

. 2021 Sep 7;S0022-3476(21)00873-8. doi: 10.1016/j.jpeds.2021.09.001. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/34506854/

In-Hospital Morbidities for Neonates With Congenital Diaphragmatic Hernia: The Impact of Defect Size and Laterality

Valerie Y Chock 1Enrico Danzer 2Sukyung Chung 3Caroline Y Noh 4Ashley H Ebanks 5Matthew T Harting 5Kevin P Lally 5Krisa P Van Meurs 4Congenital Diaphragmatic Hernia Study GroupAffiliations expand

Abstract

Objective: To determine in-hospital morbidities for neonates with right-sided congenital diaphragmatic hernia (R-CDH) compared with those with left-sided defects (L-CDH) and to examine the differential effect of laterality and defect size on morbidities.

Study design: This retrospective, multicenter, cohort study from the international Congenital Diaphragmatic Hernia Study Group (CDHSG) registry collected data from neonates with CDH surviving until hospital discharge from 90 neonatal intensive care units between 1/1/2007 and 7/31/2020. Major pulmonary, cardiac, neurologic, and gastrointestinal morbidities were compared between neonates with L-CDH and R-CDH, adjusted for prenatal and postnatal factors using logistic regression.

Results: Of 4123 survivors with CDH, those with R-CDH (n=598, 15%) compared with those with L-CDH (n=3525, 85%) had increased odds of pulmonary (1.7, 95% CI 1.4-2.2, P < .0001), cardiac (1.4, 95% CI 1.1-1.8, p=0.01), gastrointestinal (1.3, 95% CI 1.1-1.6, p=0.01), and multiple (1.6, 95% CI 1.2-2.0, p<0.001) in-hospital morbidities, with greater likelihood of morbidity with increasing defect size. There was no difference in neurologic morbidities between groups.

Conclusion: Neonates with R-CDH and larger defect size are at increased risk for in-hospital morbidities. Counseling and clinical strategies should incorporate knowledge of these risks, and approach to neonatal R-CDH should be distinct from current practices targeted to L-CDH.

Keywords: congenital diaphragmatic hernia; morbidities; neonate.

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