Abstract
Current literature for congenital diaphragmatic hernia (CDH) focuses on the comparison of the overall mortality in CDH patients. Only a few studies concentrate on analyzing the unstable patients who could not achieve surgical repair, as well as those who could but did not survive after. Hence, this study aimed to analyze the effects of various parameters on the timing of death. A retrospective analysis was performed by using the data of all CDH patients from 2003 to 2016 at a single tertiary center. Patients who were diagnosed with left-sided CDH and expired were included in the study regardless of the cause. Of the 66 expired patients, 5 were excluded due to right-sided CDH. The study population constituted a total of 61 patients, of which 31 patients expired prior to CDH repair, and 30 patients expired at different times after CDH repair. Multinomial regression analysis identified that the ECMO need (B = 20.257, p = 0.000, OR: 62.756, 95% CI 10.600–371.384) and O/E LHR (B = 20.376, p = 0.000, OR: 70.663, 95% CI 48.716–102.415) values were the independent predictors that influenced mortality in this cohort. Prenatal pulmonary measurements are the major predictors determining the severity of the disease in patients with CDH.
Highlights
It is always the most acceptable thing to learn from the successful, but this comes with a bounce-back effect because many researchers do not take the survivorship bias into account [1,2]
The study population was divided into two groups: Group 1 and Group 2
During the same time period, 39 more Congenital diaphragmatic hernia (CDH) patients were admitted for postnatal care
Summary
It is always the most acceptable thing to learn from the successful, but this comes with a bounce-back effect because many researchers do not take the survivorship bias into account [1,2]. Survivorship bias is defined as the logical error of concentrating on the patients that could survive and overlooking those that could not, which ends up with some misleading conclusions in various ways [3]. Despite the fact that antenatal diagnosis via ultrasonography (USG), assessment of prognostic variables, prenatal counseling, and therapeutic modalities to the fetus can be used to predict disease outcomes, CDH death and morbidity rates remain high. For the management of the disease and its complications, as well as the management of concomitant malformations, CDH newborns must be hospitalized for an extended amount of time, with long-term follow-up [10,11]
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