Congenital diaphragmatic hernia in the preterm infant
Background Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mort...
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| Veröffentlicht in: | Surgery 2010-08, Vol.148 (2), p.404-410 |
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| description | Background Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR). Methods Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as |
| doi_str_mv | 10.1016/j.surg.2010.03.018 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3097021</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0039606010001522</els_id><sourcerecordid>733998723</sourcerecordid><originalsourceid>FETCH-LOGICAL-c539t-fad1e1dfca8c7b100eebf8f093ee60694fe4c5f55c782b2eca04a7488c1d59363</originalsourceid><addsrcrecordid>eNp9kk2LFDEQhoMo7uzqH_AgfRFPPVaS_grIggy6Cgse1HORSVdmMnanxyS9sP_eNDOuHwdPIcnzVr28VYy94LDmwJs3h3Wcw24tID-AXAPvHrEVr6UoW9nwx2wFIFXZQAMX7DLGAwCoindP2YWAquVQdStWbya_I--SHore6eM-6N2okzPFnoJ3unC-SHsqjoEShTFfrfbpGXti9RDp-fm8Yt8-vP-6-Vjefr75tHl3W5paqlRa3XPivTW6M-2WAxBtbWdBSaJsS1WWKlPbujZtJ7aCjIZKt1XXGd7XSjbyil2f6h7n7Ui9IZ-CHvAY3KjDPU7a4d8_3u1xN92hBNWC4LnA63OBMP2YKSYcXTQ0DNrTNEdspVSqa4XMpDiRJkwxBrIPXTjgEjcecIkbl7gRJOa4s-jln_4eJL_yzcCrM6Cj0YMN2hsXf3MSmqbiKnNvTxzlNO8cBYzGkTfUu0AmYT-5__u4_kduBudd7vid7ikepjn4PCfkGAUCflkWY9mLPBLgtRDyJziftD4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>733998723</pqid></control><display><type>article</type><title>Congenital diaphragmatic hernia in the preterm infant</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Tsao, KuoJen, MD ; Allison, Nathan D., MD ; Harting, Matthew T., MD ; Lally, Pamela A., MD ; Lally, Kevin P., MD, MS</creator><creatorcontrib>Tsao, KuoJen, MD ; Allison, Nathan D., MD ; Harting, Matthew T., MD ; Lally, Pamela A., MD ; Lally, Kevin P., MD, MS</creatorcontrib><description>Background Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR). Methods Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as <37 weeks estimated gestational age at birth. Univariate and multivariate logistic regression analysis were performed. Results During the study period, 5,069 infants with CDH were entered in the registry. Of the 5,022 infants with gestational age data, there were 3,895 term infants (77.6%) and 1,127 preterm infants (22.4%). Overall survival was 68.7%. A higher percentage of term infants were treated with extracorporeal membrane oxygenation (ECMO) (33% term vs 25.6% preterm). Preterm infants had a greater percentage of chromosomal abnormalities (4% term vs 8.1% preterm) and major cardiac anomalies (6.1% term vs 11.8% preterm). Also, a significantly higher percentage of term infants had repair of the hernia (86.3% term vs 69.4% preterm). Survival for infants that underwent repair was high in both groups (84.6% term vs 77.2% preterm). Survival decreased with decreasing gestational age (73.1% term vs 53.5% preterm). The odds ratio (OR) for death among preterm infants adjusted for patch repair, ECMO, chromosomal abnormalities, and major cardiac anomalies was OR 1.68 (95% confidence interval [CI], 1.34–2.11). Conclusion Although outcomes for preterm infants are clearly worse than in the term infant, more than 50% of preterm infants still survived. Preterm infants with CDH remain a high-risk group. Although ECMO may be of limited value in the extremely premature infant with CDH, most preterm infants that live to undergo repair will survive. Prematurity should not be an independent factor in the treatment strategies of infants with CDH.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2010.03.018</identifier><identifier>PMID: 20471048</identifier><identifier>CODEN: SURGAZ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Extracorporeal Membrane Oxygenation ; Female ; General aspects ; Gestational Age ; Hernia, Diaphragmatic - mortality ; Hernia, Diaphragmatic - surgery ; Hernias, Diaphragmatic, Congenital ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Medical sciences ; Odds Ratio ; Pregnancy ; Prognosis ; Prospective Studies ; Registries ; Surgery ; Survival Analysis ; Treatment Outcome</subject><ispartof>Surgery, 2010-08, Vol.148 (2), p.404-410</ispartof><rights>Mosby, Inc.</rights><rights>2010 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2010 Mosby, Inc. All rights reserved.</rights><rights>2010 Mosby, Inc. All rights reserved. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c539t-fad1e1dfca8c7b100eebf8f093ee60694fe4c5f55c782b2eca04a7488c1d59363</citedby><cites>FETCH-LOGICAL-c539t-fad1e1dfca8c7b100eebf8f093ee60694fe4c5f55c782b2eca04a7488c1d59363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2010.03.018$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,778,782,883,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23066419$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20471048$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsao, KuoJen, MD</creatorcontrib><creatorcontrib>Allison, Nathan D., MD</creatorcontrib><creatorcontrib>Harting, Matthew T., MD</creatorcontrib><creatorcontrib>Lally, Pamela A., MD</creatorcontrib><creatorcontrib>Lally, Kevin P., MD, MS</creatorcontrib><title>Congenital diaphragmatic hernia in the preterm infant</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR). Methods Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as <37 weeks estimated gestational age at birth. Univariate and multivariate logistic regression analysis were performed. Results During the study period, 5,069 infants with CDH were entered in the registry. Of the 5,022 infants with gestational age data, there were 3,895 term infants (77.6%) and 1,127 preterm infants (22.4%). Overall survival was 68.7%. A higher percentage of term infants were treated with extracorporeal membrane oxygenation (ECMO) (33% term vs 25.6% preterm). Preterm infants had a greater percentage of chromosomal abnormalities (4% term vs 8.1% preterm) and major cardiac anomalies (6.1% term vs 11.8% preterm). Also, a significantly higher percentage of term infants had repair of the hernia (86.3% term vs 69.4% preterm). Survival for infants that underwent repair was high in both groups (84.6% term vs 77.2% preterm). Survival decreased with decreasing gestational age (73.1% term vs 53.5% preterm). The odds ratio (OR) for death among preterm infants adjusted for patch repair, ECMO, chromosomal abnormalities, and major cardiac anomalies was OR 1.68 (95% confidence interval [CI], 1.34–2.11). Conclusion Although outcomes for preterm infants are clearly worse than in the term infant, more than 50% of preterm infants still survived. Preterm infants with CDH remain a high-risk group. Although ECMO may be of limited value in the extremely premature infant with CDH, most preterm infants that live to undergo repair will survive. Prematurity should not be an independent factor in the treatment strategies of infants with CDH.</description><subject>Biological and medical sciences</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Female</subject><subject>General aspects</subject><subject>Gestational Age</subject><subject>Hernia, Diaphragmatic - mortality</subject><subject>Hernia, Diaphragmatic - surgery</subject><subject>Hernias, Diaphragmatic, Congenital</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Odds Ratio</subject><subject>Pregnancy</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk2LFDEQhoMo7uzqH_AgfRFPPVaS_grIggy6Cgse1HORSVdmMnanxyS9sP_eNDOuHwdPIcnzVr28VYy94LDmwJs3h3Wcw24tID-AXAPvHrEVr6UoW9nwx2wFIFXZQAMX7DLGAwCoindP2YWAquVQdStWbya_I--SHore6eM-6N2okzPFnoJ3unC-SHsqjoEShTFfrfbpGXti9RDp-fm8Yt8-vP-6-Vjefr75tHl3W5paqlRa3XPivTW6M-2WAxBtbWdBSaJsS1WWKlPbujZtJ7aCjIZKt1XXGd7XSjbyil2f6h7n7Ui9IZ-CHvAY3KjDPU7a4d8_3u1xN92hBNWC4LnA63OBMP2YKSYcXTQ0DNrTNEdspVSqa4XMpDiRJkwxBrIPXTjgEjcecIkbl7gRJOa4s-jln_4eJL_yzcCrM6Cj0YMN2hsXf3MSmqbiKnNvTxzlNO8cBYzGkTfUu0AmYT-5__u4_kduBudd7vid7ikepjn4PCfkGAUCflkWY9mLPBLgtRDyJziftD4</recordid><startdate>20100801</startdate><enddate>20100801</enddate><creator>Tsao, KuoJen, MD</creator><creator>Allison, Nathan D., MD</creator><creator>Harting, Matthew T., MD</creator><creator>Lally, Pamela A., MD</creator><creator>Lally, Kevin P., MD, MS</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20100801</creationdate><title>Congenital diaphragmatic hernia in the preterm infant</title><author>Tsao, KuoJen, MD ; Allison, Nathan D., MD ; Harting, Matthew T., MD ; Lally, Pamela A., MD ; Lally, Kevin P., MD, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c539t-fad1e1dfca8c7b100eebf8f093ee60694fe4c5f55c782b2eca04a7488c1d59363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Biological and medical sciences</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Female</topic><topic>General aspects</topic><topic>Gestational Age</topic><topic>Hernia, Diaphragmatic - mortality</topic><topic>Hernia, Diaphragmatic - surgery</topic><topic>Hernias, Diaphragmatic, Congenital</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Odds Ratio</topic><topic>Pregnancy</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsao, KuoJen, MD</creatorcontrib><creatorcontrib>Allison, Nathan D., MD</creatorcontrib><creatorcontrib>Harting, Matthew T., MD</creatorcontrib><creatorcontrib>Lally, Pamela A., MD</creatorcontrib><creatorcontrib>Lally, Kevin P., MD, MS</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsao, KuoJen, MD</au><au>Allison, Nathan D., MD</au><au>Harting, Matthew T., MD</au><au>Lally, Pamela A., MD</au><au>Lally, Kevin P., MD, MS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Congenital diaphragmatic hernia in the preterm infant</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2010-08-01</date><risdate>2010</risdate><volume>148</volume><issue>2</issue><spage>404</spage><epage>410</epage><pages>404-410</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><coden>SURGAZ</coden><abstract>Background Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR). Methods Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as <37 weeks estimated gestational age at birth. Univariate and multivariate logistic regression analysis were performed. Results During the study period, 5,069 infants with CDH were entered in the registry. Of the 5,022 infants with gestational age data, there were 3,895 term infants (77.6%) and 1,127 preterm infants (22.4%). Overall survival was 68.7%. A higher percentage of term infants were treated with extracorporeal membrane oxygenation (ECMO) (33% term vs 25.6% preterm). Preterm infants had a greater percentage of chromosomal abnormalities (4% term vs 8.1% preterm) and major cardiac anomalies (6.1% term vs 11.8% preterm). Also, a significantly higher percentage of term infants had repair of the hernia (86.3% term vs 69.4% preterm). Survival for infants that underwent repair was high in both groups (84.6% term vs 77.2% preterm). Survival decreased with decreasing gestational age (73.1% term vs 53.5% preterm). The odds ratio (OR) for death among preterm infants adjusted for patch repair, ECMO, chromosomal abnormalities, and major cardiac anomalies was OR 1.68 (95% confidence interval [CI], 1.34–2.11). Conclusion Although outcomes for preterm infants are clearly worse than in the term infant, more than 50% of preterm infants still survived. Preterm infants with CDH remain a high-risk group. Although ECMO may be of limited value in the extremely premature infant with CDH, most preterm infants that live to undergo repair will survive. Prematurity should not be an independent factor in the treatment strategies of infants with CDH.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>20471048</pmid><doi>10.1016/j.surg.2010.03.018</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Extracorporeal Membrane Oxygenation Female General aspects Gestational Age Hernia, Diaphragmatic - mortality Hernia, Diaphragmatic - surgery Hernias, Diaphragmatic, Congenital Humans Infant, Newborn Infant, Premature Male Medical sciences Odds Ratio Pregnancy Prognosis Prospective Studies Registries Surgery Survival Analysis Treatment Outcome |
| title | Congenital diaphragmatic hernia in the preterm infant |
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