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Observational Study
. 2021 Jul;133(13-14):674-679.
doi: 10.1007/s00508-021-01843-w. Epub 2021 Mar 30.

Risk factors for mortality in infants with congenital diaphragmatic hernia: a single center experience

Jennifer Bettina Brandt  1 , Tobias Werther  2 , Erika Groth  3 , Erik Küng  2 , Johann Golej  2 , Angelika Berger  2
Affiliations
Observational Study

Risk factors for mortality in infants with congenital diaphragmatic hernia: a single center experience

Jennifer Bettina Brandt et al. Wien Klin Wochenschr. 2021 Jul.

Abstract

Background: Despite current progress in research of congenital diaphragmatic hernia, its management remains challenging, requiring an interdisciplinary team for optimal treatment.

Objective: Aim of the present study was to evaluate potential risk factors for mortality of infants with congenital diaphragmatic hernia.

Methods: A single-center chart review of all patients treated with congenital diaphragmatic hernia over a period of 16 years, at the Medical University of Vienna, was performed. A comparison of medical parameters between survivors and non-survivors, as well as to published literature was conducted.

Results: During the observational period 66 patients were diagnosed with congenital diaphragmatic hernia. Overall survival was 84.6%. Left-sided hernia occurred in 51 patients (78.5%) with a mortality of 7.8%. In comparison, right-sided hernia occurred less frequently (n = 12) but showed a higher mortality (33.3%, p = 0.000). Critically instable patients were provided with venoarterial extracorporeal membrane oxygenation (ECMO, 32.3%, n = 21). Survival rate among these patients was 66.7%. Right-sided hernia, treatment with inhaled nitric oxide (iNO) over 15 days and the use of ECMO over 10 days were significant risk factors for mortality.

Conclusion: The survival rate in this cohort is comparable to the current literature. Parameters such as the side of the diaphragmatic defect, duration of ECMO and inhaled nitric oxide were assessed as mortality risk factors. This analysis of patients with congenital diaphragmatic hernia enhances understanding of risk factors for mortality, helping to improve management and enabling further evaluation in prospective clinical trials.

Keywords: CDH; ECMO; Inhaled nitric oxide; Pulmonary hypertension; Survival parameters.

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Conflict of interest statement

J.B. Brandt, T. Werther,E. Groth, E. Küng, J. Golej, and A. Berger declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Relative risk for death in children with congenital diaphragmatic hernia. GA < 37w gestational age below 37 weeks; R‑CDH right-sided congenital diaphragmatic hernia, PAH pulmonary hypertension; INO > 10d inhalative nitric oxide over 10 days; ECMO > 10d extracorporeal membrane oxygenation over 10 days, CI confidence interval
See this image and copyright information in PMC

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