Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;55(1):90-101.
doi: 10.1002/ppul.24516. Epub 2019 Sep 10.

Clinical features and outcomes associated with tracheostomy in congenital diaphragmatic hernia

Sahar Al Baroudi  1 , Joseph M Collaco  1 , Pamela A Lally  2 , Matthew T Harting  2 , Eric B Jelin  3
Affiliations

Clinical features and outcomes associated with tracheostomy in congenital diaphragmatic hernia

Sahar Al Baroudi et al. Pediatr Pulmonol. 2020 Jan.

Abstract

Introduction: The purpose of this study was to examine the clinical features/outcomes associated with tracheostomy in infants with congenital diaphragmatic hernia (CDH).

Methods: The study population consisted of liveborn infants reported to the CDH Study Group registry between 2007 and 2017. Subjects were identified as having a tracheostomy if they were discharged or transferred to another hospital with tracheostomy and/or on mechanical ventilation. Multivariate mixed models were used for analyses.

Results: The registry population consisted of 5434 subjects, of whom 230 (4.2%) underwent tracheostomy placement. Only 3830 (70.5%) infants survived until discharge/transfer. The median age of tracheostomy placement was 3.3 months (range, 1.3-13.4 when known; n = 58 out of 154 survivors). The mortality rate among subjects with tracheostomy was 32.8% with a median of 37 days (range, 8-189 when known; n = 32 out of 75 deceased) ensuing between tracheostomy placement and death. The clinical features found to be associated with increased odds ratio of tracheostomy placement included male sex, birth weight, 5-minute APGAR score, defect size, liver in chest, ECMO use, cardiac abnormality, other congenital abnormalities, pulmonary hypertension, and the presence of a feeding tube. There was center variation in the rate of tracheostomy placement, which may be partially accounted for by disease severity, but not center size.

Conclusion: There are several clinical features that are associated with increased likelihood of tracheostomy placement. Most deaths in subjects with tracheostomies occurred outside the immediate postoperative period. The utility of a standardized protocol for tracheostomy in infants with CDH should be considered.

Keywords: congenital diaphragmatic hernia; mechanical ventilators; tracheostomy.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Age at tracheostomy placement
FIGURE 2
FIGURE 2
Hospital length of stay
FIGURE 3
FIGURE 3
Age of death for patients with tracheostomies
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Stege G, Fenton A, Jaffray B. Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics. 2003;112(3):532–535. 10.1542/peds.112.3.532 - DOI - PubMed
    1. Gallot D, Boda C, Ughetto S, et al. Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol. 2007;29(3):276–283. 10.1002/uog.3863 - DOI - PubMed
    1. Burgos CM, Frenckner B. Addressing the hidden mortality in CDH: a population-based study. J Pediatr Surg. 2017;52(4):522–525. 10.1016/j.jpedsurg.2016.09.061 - DOI - PubMed
    1. Partridge EA, Peranteau WH, Herkert L, et al. Right- versus left-sided congenital diaphragmatic hernia: a comparative outcomes analysis. J Pediatr Surg. 2016;51(6):900–902. 10.1016/j.jpedsurg.2016.02.049 - DOI - PubMed
    1. Hedrick HL, Danzer E, Merchant A, et al. Liver position and lung-to-head ratio for prediction of extracorporeal membrane oxygenation and survival in isolated left congenital diaphragmatic hernia. Am J Obstet Gynecol. 2007;197(4):422.e1–422.e4. 10.1016/j.ajog.2007.07.001 - DOI - PubMed

Publication types