A population-based study of congenital diaphragmatic hernia: Impact of associated anomalies and preoperative blood gases on survival

Jeffrey R. Kaiser, Charles R. Rosenfeld

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background/Purpose: Although neonatal care has improved over the past 20 years, mortality rate with congenital diaphragmatic hernia (CDH) remains 50% to 60%, possibly reflecting differences in management or selection biases. The authors determined the incidence, outcome, effect of coexisting anomalies, and prognostic indicators for neonates with CDH in a single inborn population older than 13 years. Methods: Forty-three neonates with CDH, those symptomatic within the first 6 hours of life, were identified using a validated neonatal database and diagnosis coding data from medical records among 180,643 live inborn neonates delivered at Parkland Memorial Hospital between 1983 and 1995. Charts were reviewed for prenatal history, demographic variables, presence of coexisting malformations, preoperative arterial blood gases, surgical findings, and outcome. Survival to hospital discharge was the primary outcome variable. Results: The incidence of CDH was 1 in 4,200 live births; overall survival rate was 51%. Thirty-two (74%) neonates underwent surgical repair, often at less than 8 hours of life; postoperative mortality rate was 31%. Eighteen (42%) had coexisting major anomalies or chromosomal abnormalities. Eighty percent of neonates with isolated CDH survived, whereas 89% with CDH and associated defects died. Nonsurvivors had lower birth weights and Apgar scores, were more acidotic, and had more severe respiratory compromise. When best preoperative pH was ≥ 7.25 or Paco2 ≤ 50 mm Hg, 80% of neonates survived. Conclusion: In this inborn population-based review of neonatal CDH between 1983 and 1995, the best predictors of survival were the presence or absence of other anomalies and the best preoperative Paco2 and pH.

Original languageEnglish (US)
Pages (from-to)1196-1202
Number of pages7
JournalJournal of Pediatric Surgery
Volume34
Issue number8
DOIs
StatePublished - Aug 1999

Fingerprint

Gases
Population
Apgar Score
Mortality
Selection Bias
Incidence
Live Birth
Congenital Diaphragmatic Hernias
Birth Weight
Chromosome Aberrations
Medical Records
Survival Rate
History
Demography
Databases

Keywords

  • Congenital diaphragmatic hernia
  • Neonate
  • Population-based study
  • Pulmonary hypoplasia
  • Survival prediction

ASJC Scopus subject areas

  • Surgery

Cite this

@article{9634708a82174041a461e7f673acf74a,
title = "A population-based study of congenital diaphragmatic hernia: Impact of associated anomalies and preoperative blood gases on survival",
abstract = "Background/Purpose: Although neonatal care has improved over the past 20 years, mortality rate with congenital diaphragmatic hernia (CDH) remains 50{\%} to 60{\%}, possibly reflecting differences in management or selection biases. The authors determined the incidence, outcome, effect of coexisting anomalies, and prognostic indicators for neonates with CDH in a single inborn population older than 13 years. Methods: Forty-three neonates with CDH, those symptomatic within the first 6 hours of life, were identified using a validated neonatal database and diagnosis coding data from medical records among 180,643 live inborn neonates delivered at Parkland Memorial Hospital between 1983 and 1995. Charts were reviewed for prenatal history, demographic variables, presence of coexisting malformations, preoperative arterial blood gases, surgical findings, and outcome. Survival to hospital discharge was the primary outcome variable. Results: The incidence of CDH was 1 in 4,200 live births; overall survival rate was 51{\%}. Thirty-two (74{\%}) neonates underwent surgical repair, often at less than 8 hours of life; postoperative mortality rate was 31{\%}. Eighteen (42{\%}) had coexisting major anomalies or chromosomal abnormalities. Eighty percent of neonates with isolated CDH survived, whereas 89{\%} with CDH and associated defects died. Nonsurvivors had lower birth weights and Apgar scores, were more acidotic, and had more severe respiratory compromise. When best preoperative pH was ≥ 7.25 or Paco2 ≤ 50 mm Hg, 80{\%} of neonates survived. Conclusion: In this inborn population-based review of neonatal CDH between 1983 and 1995, the best predictors of survival were the presence or absence of other anomalies and the best preoperative Paco2 and pH.",
keywords = "Congenital diaphragmatic hernia, Neonate, Population-based study, Pulmonary hypoplasia, Survival prediction",
author = "Kaiser, {Jeffrey R.} and Rosenfeld, {Charles R.}",
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doi = "10.1016/S0022-3468(99)90151-3",
language = "English (US)",
volume = "34",
pages = "1196--1202",
journal = "Journal of Pediatric Surgery",
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T1 - A population-based study of congenital diaphragmatic hernia

T2 - Impact of associated anomalies and preoperative blood gases on survival

AU - Kaiser, Jeffrey R.

AU - Rosenfeld, Charles R.

PY - 1999/8

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N2 - Background/Purpose: Although neonatal care has improved over the past 20 years, mortality rate with congenital diaphragmatic hernia (CDH) remains 50% to 60%, possibly reflecting differences in management or selection biases. The authors determined the incidence, outcome, effect of coexisting anomalies, and prognostic indicators for neonates with CDH in a single inborn population older than 13 years. Methods: Forty-three neonates with CDH, those symptomatic within the first 6 hours of life, were identified using a validated neonatal database and diagnosis coding data from medical records among 180,643 live inborn neonates delivered at Parkland Memorial Hospital between 1983 and 1995. Charts were reviewed for prenatal history, demographic variables, presence of coexisting malformations, preoperative arterial blood gases, surgical findings, and outcome. Survival to hospital discharge was the primary outcome variable. Results: The incidence of CDH was 1 in 4,200 live births; overall survival rate was 51%. Thirty-two (74%) neonates underwent surgical repair, often at less than 8 hours of life; postoperative mortality rate was 31%. Eighteen (42%) had coexisting major anomalies or chromosomal abnormalities. Eighty percent of neonates with isolated CDH survived, whereas 89% with CDH and associated defects died. Nonsurvivors had lower birth weights and Apgar scores, were more acidotic, and had more severe respiratory compromise. When best preoperative pH was ≥ 7.25 or Paco2 ≤ 50 mm Hg, 80% of neonates survived. Conclusion: In this inborn population-based review of neonatal CDH between 1983 and 1995, the best predictors of survival were the presence or absence of other anomalies and the best preoperative Paco2 and pH.

AB - Background/Purpose: Although neonatal care has improved over the past 20 years, mortality rate with congenital diaphragmatic hernia (CDH) remains 50% to 60%, possibly reflecting differences in management or selection biases. The authors determined the incidence, outcome, effect of coexisting anomalies, and prognostic indicators for neonates with CDH in a single inborn population older than 13 years. Methods: Forty-three neonates with CDH, those symptomatic within the first 6 hours of life, were identified using a validated neonatal database and diagnosis coding data from medical records among 180,643 live inborn neonates delivered at Parkland Memorial Hospital between 1983 and 1995. Charts were reviewed for prenatal history, demographic variables, presence of coexisting malformations, preoperative arterial blood gases, surgical findings, and outcome. Survival to hospital discharge was the primary outcome variable. Results: The incidence of CDH was 1 in 4,200 live births; overall survival rate was 51%. Thirty-two (74%) neonates underwent surgical repair, often at less than 8 hours of life; postoperative mortality rate was 31%. Eighteen (42%) had coexisting major anomalies or chromosomal abnormalities. Eighty percent of neonates with isolated CDH survived, whereas 89% with CDH and associated defects died. Nonsurvivors had lower birth weights and Apgar scores, were more acidotic, and had more severe respiratory compromise. When best preoperative pH was ≥ 7.25 or Paco2 ≤ 50 mm Hg, 80% of neonates survived. Conclusion: In this inborn population-based review of neonatal CDH between 1983 and 1995, the best predictors of survival were the presence or absence of other anomalies and the best preoperative Paco2 and pH.

KW - Congenital diaphragmatic hernia

KW - Neonate

KW - Population-based study

KW - Pulmonary hypoplasia

KW - Survival prediction

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