Adv Pediatr Surg.  2018 Dec;24(2):68-75. 10.13029/aps.2018.24.2.68.

Pneumothorax Is a Significant Risk Factor for Mortality in Congenital Diaphragmatic Hernia: A Single Center Experience

Affiliations
  • 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Sanghoone.lee@samsung.com

Abstract

PURPOSE
We describe our experience in managing congenital diaphragmatic hernia (CDH) in neonates.
METHODS
From February 1995 to July 2014, 64 neonates diagnosed with CDH were managed. The medical records of these neonates were retrospectively reviewed.
RESULTS
There were 40 males and 24 females. CDH was on the left side in 44 cases (68.8%), on the right side in 19 cases (29.7%) and bilateral in 1 case (1.6%). Forty-six patients (71.9%) received surgical repair of the hernia while 18 patients (28.1%) died prior to surgery. The timing of surgery was mean 7.0 days after birth. Extracorporeal membrane oxygenation was used in six patients (9.4%), High-frequency oscillation ventilation was used in 49 patients (76.6%), and nitric oxide was used in 42 patients (65.6%). Thirty-three cases (71.7%) of CDH repair were done via open laparotomy, 3 cases (6.6%) by open thoracotomy. and minimally invasive thoracoscopic repair was done in 10 cases (21.7%). Ten cases (21.8%) required patch repair of the CDH. Barotrauma and pneumothorax of the contralateral lung was seen in 16 cases, leading to death in 15 of these cases. The overall survival rate was 48.4% (31/64) and postoperative survival rate was 67.4% (31/46). When all patients are divided into 3 groups by era and analyzed by logistic regression models, the mortality outcome of recent era (2009-2014) was significantly better than that of intermediate era (2002-2008) (29% vs. 71%, p=0.006) and tended to be better than that of past era (1995-2001) (42% vs. 71%, p=0.062).
CONCLUSION
The overall survival of neonates with CDH at our center has improved over the last two decades. Sixty-four neonates with CDH were managed at a single center and their overall survival was 48.4%. The risk factors for mortality include the occurrence of pneumothorax and right side lesions.

Keyword

Congenital diaphragmatic hernias; Pneumothorax

MeSH Terms

Barotrauma
Extracorporeal Membrane Oxygenation
Female
Hernia
Hernias, Diaphragmatic, Congenital*
High-Frequency Ventilation
Humans
Infant, Newborn
Laparotomy
Logistic Models
Lung
Male
Medical Records
Mortality*
Nitric Oxide
Parturition
Pneumothorax*
Retrospective Studies
Risk Factors*
Survival Rate
Thoracotomy
Nitric Oxide

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