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Research: Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study.

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Research: Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study.

Pediatr Surg Int. 2020 Apr 28. doi: 10.1007/s00383-020-04659-3. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/?cmd=historysearch&querykey=1

Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study.

Masahata K1Usui N2Nagata K3Terui K4Hayakawa M5Amari S6Masumoto K7Okazaki T8Inamura N9Urushihara N10Toyoshima K11Uchida K12Furukawa T13Okawada M14Yokoi A15Okuyama H16Taguchi T3.

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Abstract

PURPOSE:

This study aimed to elucidate the clinical characteristics of neonates with congenital diaphragmatic hernia (CDH) associated with pneumothorax and evaluate the risk factors for the development of pneumothorax.

METHODS:

A retrospective cohort study was conducted in the 15 institutions participating in the Japanese CDH Study Group. A total of 495 neonates with isolated CDH who were born between 2011 and 2018 were analyzed in this study.

RESULTS:

Among the 495 neonates with isolated CDH, 52 (10.5%) developed pneumothorax. Eighteen (34.6%) patients developed pneumothorax before surgery, while 34 (65.4%) developed pneumothorax after surgery. The log-rank test showed that the cumulative survival rate was significantly lower in patients with pneumothorax than in those without pneumothorax. Univariate analysis revealed significant differences between patients with pneumothorax and those without pneumothorax with regard to the best oxygenation index within 24 h after birth, mean airway pressure (MAP) higher than 16 cmH2O, diaphragmatic defect size, and need for patch closure. Multiple logistic regression analysis indicated that only the MAP was associated with an increased risk of pneumothorax.

CONCLUSIONS:

The cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients.

KEYWORDS:

Congenital diaphragmatic hernia; Gentle ventilation; Pneumothorax; Pulmonary hypoplasia; Ventilator-induced lung injuryPMID: 32346849 DOI: 10.1007/s00383-020-04659-3

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