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Research: The efficacy of the postnatal nasogastric tube position as a prognostic marker of left-sided isolated congenital diaphragmatic hernia

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Research: The efficacy of the postnatal nasogastric tube position as a prognostic marker of left-sided isolated congenital diaphragmatic hernia

Pediatr Surg Int

. 2022 Sep 23.

 doi: 10.1007/s00383-022-05226-8. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36138323/

The efficacy of the postnatal nasogastric tube position as a prognostic marker of left-sided isolated congenital diaphragmatic hernia

Jun Kono 1Kouji Nagata 2Keita Terui 3Shoichiro Amari 4Katsuaki Toyoshima 5Noboru Inamura 6Yuhki Koike 7Masaya Yamoto 8Tadaharu Okazaki 9Yuta Yazaki 10Hiroomi Okuyama 11Masahiro Hayakawa 12Taizo Furukawa 13Kouji Masumoto 14Akiko Yokoi 15Noriaki Usui 16Tatsuro Tajiri 1

Affiliations expand

Abstract

Purpose: The prenatal diagnosis of the stomach position in congenital diaphragmatic hernia (CDH) has been a reliable prognostic factor, but few studies have focused on the postnatal position. We therefore evaluated the significance of the nasogastric (NG) tube position just after birth.

Methods: The Japanese CDH Study Group database enrolled 1037 CDH neonates over 15 years. In our multicenter retrospective study, 464 cases of left-sided isolated CDH with prenatal diagnoses were divided into two groups: NG tube below the diaphragm (BD; n = 190) or above the diaphragm (AD; n = 274). The primary outcome was the 90-day survival rate, and the secondary outcomes were mechanical ventilation duration, hospitalization duration, and recurrence rate.

Results: The BD group had a significantly higher 90-day survival rate (98.4 vs. 89.4%, p < 0.001), shorter mechanical ventilation (11 vs. 19 days, p < 0.001), shorter hospitalization (38 vs. 59 days, p < 0.001), and lower recurrence rate (p = 0.002) than the AD group. A multivariate analysis showed that BD (adjusted odds ratio, 3.68; 95% confidence interval 1.02-13.30) was a favorable prognostic factor for the 90-day survival.

Conclusion: The assessment of the NG tube position revealed it to be a reliable prognostic factor of left-sided isolated CDH. Therefore, it should be included as a routine assessment.

Keywords: Congenital diaphragmatic hernia; Mortality; Nasogastric tube; Postnatal prognostic factor; Stomach position.

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