Perinatology.  2018 Jun;29(2):72-77. 10.14734/PN.2018.29.2.72.

Trends in Treatment Outcome and Critical Predictors of Mortality for Congenital Diaphragmatic Hernia in a Single Center

Affiliations
  • 1Division of Neonatalogy, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. arkim@amc.seoul.kr
  • 2Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  • 3Division of Pediatric Surgery, Department of Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. kimdy@amc.seoul.kr
  • 4Department of Obstetrics and Gynecology, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
To review trends in treatment outcomes, to determine risk factors for mortality, and to present a cut-off values of observed/expected lung to head ratio (O/E LHR) predicting mortality in infants with congenital diaphragmatic hernia (CDH).
METHODS
A retrospective study of infants with CDH treated in the neonatal intensive care unit at tertiary medical center over 27 years (1989 to 2016) was done. We analyzed the factors associated with mortality and based on significant factors in predicting the mortality, the best cut-off value of O/E LHR was sought.
RESULTS
A total of 264 patients were included for the study. The mean gestational age and birth weight were 38.0±2.2 weeks and 2,934.2±578.2 g, respectively. Seventy nine patients (29.9%) died. The range of yearly mortality rate varied from 0 to 67%. Prenatal, neonatal, and surgical factors associated to mortality included time of prenatal diagnosis, polyhydramnios, O/E LHR, associated major congenital anomalies (cardiac, gastrointestinal or chromosomal anomalies), gestational age, birth weight, Apgar scores, initial pH and pCO2, and number of herniated organs. Among 62 fetuses whose O/E LHR were available, O/E LHR and major congenital anomalies were independent risk factors for mortality (area under curve=0.918), fetuses with O/E LHR < 44% without congenital anomalies showed predicted mortality of 72% and fetuses with O/E LHR ≥44% without congenital anomalies showed expected mortality of 7%.
CONCLUSION
The mortality of Infants with CDH has not improved despite advance of neonatal care. The O/E LHR and the presence of major congenital anomalies could be used adjunctively when counseling parents about the prognosis.

Keyword

Congenital diaphragmatic hernia; Prenatal diagnosis; Mortality

MeSH Terms

Birth Weight
Counseling
Fetus
Gestational Age
Head
Hernias, Diaphragmatic, Congenital*
Humans
Hydrogen-Ion Concentration
Infant
Infant, Newborn
Intensive Care, Neonatal
Lung
Mortality*
Parents
Polyhydramnios
Prenatal Diagnosis
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome*
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