Risk factors and outcomes for congenital diaphragmatic hernia in neonatal intensive care unit patients

Abstract

Objectives. Congenital diaphragmatic hernia (CDH) is one of the most common and serious congenital disorders seen in the neonatal intensive care unit (NICU) and it is associated with a high mortality. In order to determine the risk factors and outcomes of CDH, we summarized data from a 10 year period.Methods. A retrospective study was conducted on 38 CDH patients. Clinical characteristics and risk factors were compared and non-conditional logistic regression analysis was performed to determine independent predictors for mortality. Results. Thirty patients, from a total of 38, underwent surgery for CDH. The total survival rate in patients with CDH was 63.2%(24/38) and the overall operative mortality was 20.0% (6/30). There was a significant difference between CDH patients who survived (n=24) and those who died (n=14) in the age on admission, 5-minute Apgar score, onset of respiratory distress, cardiac malformations and presence of persistent pulmonary hypertension of newborn (PPHN). Using logistic regression analysis, the following factors independently predicted mortality: the age on admission (OR: 8.15, 95%CI: 1.43 to 46.41) and cardiac malformations (OR: 18.54, 95%CI: 1.32 to 259.62). Moreover, when we compared CDH patients who survived after surgery (n=24) with those who died (n=6), there was a significant difference in the admission age, 1-minute Apgar score, presence of PPHN, lung hypoplasia, time of stabilization prior to surgery, and highest oxygenation index after surgery. Conclusions. Mortality was very high in CDH patients and was associated with care procedures. Risk factors for mortality in neonatal CDH were the age on admission and associated malformations.