. 2023 May 15;113481.
doi: 10.1016/j.jpeds.2023.113481. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/37196780/
Sex-specific Differences in Congenital Diaphragmatic Hernia Mortality
Shelby R Sferra 1, Matthew Guo 1, Andres J Gonzalez Salazar 1, Annalise B Penikis 1, Abigail Engwall-Gill 1, Ashley Ebanks 2, Matthew T Harting 2, Joseph M Collaco 3, Shaun M Kunisaki 4; CDH Study Group
- PMID: 37196780
- DOI: 10.1016/j.jpeds.2023.113481
Objective: To compare disease severity and mortality differences between female and male patients with CDH.
Study design: We queried the Congenital Diaphragmatic Hernia Study Group database for CDH neonates managed between 2007-2018. Female and males were compared in statistical analyses using t-tests, chi-squared tests, and Cox regression, as appropriate (p≤0.05).
Results: There were 7288 CDH patients, of which 3048 (41.8%) were female. Females weighed less on average at birth than males (2.84 kg vs. 2.97 kg, p<0.001) despite comparable gestational age. Females had similar rates of extracorporeal life support (ECLS) utilization (27.8% vs. 27.3%, p=0.65). Although both cohorts had equivalent defect size and rates of patch repair, female patients had increased rates of intrathoracic liver herniation (49.2% vs. 45.9%, p=0.01) and pulmonary hypertension (86.6% vs. 81.1%, p<0.001). Females had lower survival rates at 30-days (77.3% vs. 80.1%, p=0.003) and overall lower survival to discharge (70.2% vs. 74.2%, p<0.001). Subgroup analysis revealed that increased mortality was significant among those who underwent repair but were never supported on ECLS (p=0.005). On Cox regression analysis, female sex was independently associated with mortality (adjusted Hazard Ratio 1.32, p=0.02).
Conclusion: After controlling for established prenatal and postnatal predictors of mortality, female sex remains independently associated with a higher risk of mortality in CDH. Further study into the underlying causes for sex-specific disparities in CDH outcomes is warranted.
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