Research: Predictors of Mortality in Very Low Birth Weight Neonates With Congenital Diaphragmatic Hernia

J Pediatr Surg

. 2024 Feb 1:S0022-3468(24)00064-2.

 doi: 10.1016/j.jpedsurg.2024.01.032. Online ahead of print.

Predictors of Mortality in Very Low Birth Weight Neonates With Congenital Diaphragmatic Hernia

Emily Nes 1Priyanka V Chugh 1Gregory Keefe 1Katherine Culbreath 1Kate A Morrow 2Danielle E Y Ehret 3Roger F Soll 3Jeffrey D Horbar 3Matthew T Harting 4Kevin P Lally 4Biren P Modi 1Tom Jaksic 1Erika M Edwards 5

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Background: Limited data exists regarding the mortality of very low birth weight (VLBW) neonates with congenital diaphragmatic hernia (CDH). This study aims to quantify and determine predictors of mortality in VLBW neonates with CDH.

Methods: This analysis of 829 U.S. NICUs included VLBW [birth weight ≤1500g] neonates, born 2011-2021 with and without CDH. The primary outcome was in-hospital mortality. A generalized estimating equation regression model determined the adjusted risk ratio (ARR) of mortality.

Results: Of 426,140 VLBW neonates, 535 had CDH. In neonates with CDH, 48.4% had an additional congenital anomaly vs 5.5% without. In-hospital mortality for neonates with CDH was 70.4% vs 12.6% without. Of those with CDH, 73.3% died by day of life 3. Of VLBW neonates with CDH, 38% were repaired. A subgroup analysis was performed on 60% of VLBW neonates who underwent delivery room intubation or mechanical ventilation, as an indicator of active treatment. Mortality in this group was 62.7% for neonates with CDH vs 16.4% without. Higher Apgars at 1 min and repair of CDH were associated with lower mortality (ARR 0.91; 95%CI 0.87,0.96 and ARR 0.28; 0.21,0.39). The presence of additional congenital anomalies was associated with higher mortality (ARR 1.14; 1.01,1.30).

Conclusion: These benchmark data reveal that VLBW neonates with CDH have an extremely high mortality. Almost half of the cohort have an additional congenital anomaly which significantly increases the risk of death. This study may be utilized by providers and families to better understand the guarded prognosis of VLBW neonates with CDH.

Type of study: Level II.

Level of evidence: Level II.

Keywords: Congenital anomaly; Congenital diaphragmatic hernia; Very low birth weight neonates.

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