Research: Post-natal prognostic factors in CDH: experience of 11 years in a referral center in Brazil

Clinics (Sao Paulo)

. 2023 May 27;78:100217.

 doi: 10.1016/j.clinsp.2023.100217. eCollection 2023.

Post-natal prognostic factors in CDH: experience of 11 years in a referral center in Brazil

Camila Pinho Brasileiro Martins Nam 1Carolina Vieira Campos 2Gabriela Nunes Leal 3Uenis Tannuri 4Maria Esther Jurfest Rivero Ceccon 4Werther Brunow de Carvalho 4

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Objective: To describe post-natal risk factors associated with death in Newborns (NB) with Congenital Diaphragmatic Hernia (CDH) in a Brazilian reference center.

Methods: In this retrospective cohort study, post-natal clinical factors of all NB diagnosed with CDH were reviewed in an 11-year period (2007‒2018). The primary outcome was death. Secondary outcomes included clinical features, prognostic indexes, type of mechanical ventilation, complications during hospitalization and surgical repair.

Results: After applying the exclusion criteria, the authors analyzed 137 charts. Overall mortality was 59% (81/137), and the highest rates were observed for low-birth-weight NB (87%), syndromic phenotype (92%), and those with major malformations (100%). Prognostic indexes such as Apgar, SNAPPE-II and 24hOI (best oxygenation index in 24 hours) were all associated with poor evolution. In a multivariate analysis, only birth weight and 24hOI were statistically significant risk factors for mortality, with a reduction in mortality risk of 17.1% (OR = 0.829, 95% IC 0.72‒0.955, p = 0.009) for each additional 100g at birth and an increase by 26.5% (OR = 1.265, 95% IC 1.113‒1.436, p = 0.0003) for each unitary increase at the 24hOI.

Conclusion: Prognostic indexes are an important tool for predicting outcomes and improving resource allocation. Post-natal risk factors may be more suitable for settings where antenatal diagnosis is not universal. Classical risk factors, such as prematurity, low birth weight, higher need for supportive care, and poorer prognostic indexes were associated with mortality in our CDH population.

Keywords: Congenital Diaphragmatic Hernia; Mortality; Neonatal Intensive Care; Oxygenation Index; Prognosis.

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