144 Incidence, Risk Factors and Severity of Pulmonary Morbidity in Infants with Congenital Diaphragmatic Hernia Born in High-Volume Centres in Europe

Abstract

Background and aims: Newborns with congenital diaphragmatic hernia (CDH) may develop chronic lung disease (CLD). Our aim was to determine the incidence, severity and risk factors of CLD in infants with CDH. Methods: Data were collected about 426 CDH patients born between 2005 and 2008 at 8 high-volume centres (> 10 admissions of infants with CDH per year) in Europe. The primary endpoint was CLD, defined as oxygen dependency at day 28. The severity of CLD (mild: FiO2 0.21; moderate: FiO2 0.22-0.29; severe: FiO2 ≥ 0.30 or CPAP/mechanical ventilation) was determined at day 56 or at discharge, whichever came first. Results: At day 28, the mortality rate was 28% and the CLD incidence was 31%. Of all patients with CLD, 31% had severe CLD, 15% moderate CLD and 54% had mild CLD. Compared to patients without CLD, patients with CLD had a lower lung-to-head ratio (p< 0.001), more often had an intrathoracic liver position (p< 0.001), required treatment for pulmonary hypertension (p< 0.001), had a patch repair (p< 0.001), developed a pneumothorax (p< 0.001) and required ECMO (p< 0.001). Independent risk factors for CLD were an intrathoracic liver position (OR 5.9, 95% CI 3.9-10.4) and a lower gestational age at birth (OR 0.86, 95% CI 0.73-0.97). Patients with severe CLD more often had a pneumothorax (p< 0.001), patch repair (p=0.035) and ECMO treatment (p< 0.001) than patients with mild to moderate CLD. Conclusion: Pulmonary morbidity, which is a major problem in infants with CDH, can be identified antenatally.