Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility

Marnie Goodwin Wilson, Alana Beres, Robert Baird, Jean Martin Laberge, Erik D. Skarsgard, Pramod S. Puligandla

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

AbstractPurpose Little is known about liveborn CDH patients who die without surgery. We audited a national CDH cohort to determine whether these patients were different from patients who received CDH repair. Methods A national CDH database was analyzed (2005-2009). After excluding infants with severe physiologic instability and genetic/congenital malformations, a potential surgical candidate (PSC) subgroup was identified. PSCs were compared to the operative group (OG) and the operative non-survivor (ONS) subgroup. Standard statistical analyses were performed. Results Of 275 liveborns, 35 (13%) died without surgery. The PSC subgroup (n = 11) had a median survival of 10 days (range: 3-18). Ten of 11 PSC infants were treated in ECMO centers, with 4 receiving ECMO. No differences in BW, GA, and rates of minor malformation were observed between PSC and OG patients. While neonatal illness severity (SNAP-II) predicted overall mortality, SNAP-II scores were similar between PSC and ONS groups (34 vs. 29; p = 0.431). Furthermore, greater than 80% of infants with SNAP-II scores between 30 and 39 survived in the OG cohort. Conclusion Our analysis demonstrated that PSCs were similar to infants offered surgery based on illness severity and the presence of congenital malformations. We suggest that criteria for surgical ineligibility be developed to standardize the selection of surgical candidates.

Original languageEnglish (US)
Pages (from-to)924-929
Number of pages6
JournalJournal of Pediatric Surgery
Volume48
Issue number5
DOIs
StatePublished - May 2013

Keywords

  • CAPSNet
  • Congenital diaphragmatic hernia
  • Mortality outcomes
  • Surgical ineligibility

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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