Risk Factors for Chronic Lung Disease and Mortality in Newborns with Congenital Diaphragmatic Hernia

Abstract

Background: Congenital diaphragmatic hernia (CDH) is associated with a mortality rate of 10–35% in live-born infants. Moreover, CDH survivors have a substantial risk of developing long-term pulmonary sequelae, such as bronchopulmonary dysplasia (BPD). Objectives: This study aims to evaluate risk factors associated with BPD and mortality in neonates with CDH, with particular focus on the initial ventilation mode. Methods: Eligible for inclusion were live-born infants with CDH born from 2001 through 2006 at the centers participating in the CDH Study Group. BPD (defined as oxygen dependency at day 30) and/or mortality by day 30 served as the primary endpoint. Results: A total of 2,078 neonates were included in the analysis. At day 30, 56% of the patients had either died or met the criteria for BPD. In infants who survived until day 30, the prevalence of BPD was 41%. The overall mortality rate was 31%. High-frequency oscillatory ventilation as initial ventilation mode, a right-sided defect, a prenatal diagnosis, a lower Apgar score at 5 min, a cardiac anomaly, a chromosomal anomaly and a lower gestational age were all associated with BPD and/or mortality by day 30. Conclusions: Despite improvements in neonatal care, the rates of BPD and early mortality in newborns with CDH are still considerable. Several important risk factors for a worse outcome are reported in this nonrandomized prospective observational study.

Congenital diaphragmatic hernia

“…These patients have a high incidence of respiratory, nutritional, musculoskeletal, neurological and gastrointestinal morbidities [46,[90][91][92]. Furthermore, the recent improved survival of very sick babies is associated with increased, particularly pulmonary, morbidity among survivors [2,46] persisting beyond the initial hospitalisation, especially in those treated with ECMO [93,94]. SPOEL et al [95] recently observed that mean maximal expiratory flows at functional residual capacity (FRC) were significantly lower than predicted values at 6 and 12 months of age in CDH survivors.…”

“…It is associated with high mortality and although improvements in medical and surgical management have improved the outlook, survival remains at 60-70% [1][2][3][4][5][6]. Newer modalities, including antenatal screening and intervention, are available but are often introduced without formal evaluation.…”

Increased TGF-β: a drawback of tracheal occlusion in human and experimental congenital diaphragmatic hernia?

“…Because mechanical ventilation and oxygen therapy are standard treatments for neonatal respiratory insufficiency, CDH survivors treated or not by FETO are at high risk of developing BPD (15,59). Despite increased lung growth, temporary TO did not noticeably improve neonatal respiratory function in human and experimental CDH (17,31).…”

Hernia diafragmática congénita bilateral de diagnóstico tardío: reporte de un caso

“…3,4 La presencia de HDC de diagnóstico tardío representa el 14% de las hernias diafragmáticas. Son frecuentemente unilaterales e izquierdas, aunque un 10% pueden ser HDC bilaterales.…”