Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study

• Published in: BMC Pediatrics
• Main Author: Lum L.C.S.; Ramanujam T.M.; Yik Y.I.; Lee M.L.; Chuah S.L.; Breen E.; Zainal-Abidin A.S.; Singaravel S.; Thambidorai C.R.; de Bruyne J.A.; Nathan A.M.; Thavagnanam S.; Eg K.P.; Chan L.; Abdel-Latif M.E.; Gan C.S.
• Format: Article
• Language: English
• Published: BioMed Central Ltd 2022
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133623295&doi=10.1186%2fs12887-022-03453-5&partnerID=40&md5=1b1c9fbb8aa3f67ef8f7f79bbb2b0cef

Background: Most studies examining survival of neonates with congenital diaphragmatic hernia (CDH) are in high-income countries. We aimed to describe the management, survival to hospital discharge rate, and factors associated with survival of neonates with unilateral CDH in a middle-income country. Methods: We retrospectively reviewed the medical notes of neonates with unilateral CDH admitted to a pediatric intensive care unit (PICU) in a tertiary referral center over a 15-year period, from 2003–2017. We described the newborns’ respiratory care pathways and then compared baseline demographic, hemodynamic, and respiratory indicators between survivors and non-survivors. The primary outcome measure was survival to hospital discharge. Results: Altogether, 120 neonates were included with 43.3% (52/120) diagnosed antenatally. Stabilization occurred in 38.3% (46/120) with conventional ventilation, 13.3% (16/120) with high-frequency intermittent positive-pressure ventilation, and 22.5% (27/120) with high frequency oscillatory ventilation. Surgical repair was possible in 75.0% (90/120). The overall 30-day survival was 70.8% (85/120) and survival to hospital discharge was 66.7% (80/120). Survival to hospital discharge tended to improve over time (p > 0.05), from 56.0% to 69.5% before and after, respectively, a service reorganization. For those neonates who could be stabilized and operated on, 90.9% (80/88) survived to hospital discharge. The commonest post-operative complication was infection, occurring in 43.3%. The median survivor length of stay was 32.5 (interquartile range 18.8–58.0) days. Multiple logistic regression modelling showed vaginal delivery (odds ratio [OR] = 4.8; 95% confidence interval [CI] [1.1–21.67]; p = 0.041), Apgar score ≥ 7 at 5 min (OR = 6.7; 95% CI [1.2–36.3]; p = 0.028), and fraction of inspired oxygen (FiO2) < 50% at 24 h (OR = 89.6; 95% CI [10.6–758.6]; p < 0.001) were significantly associated with improved survival to hospital discharge. Conclusions: We report a survival to hospital discharge rate of 66.7%. Survival tended to improve over time, reflecting a greater critical volume of cases and multi-disciplinary care with early involvement of the respiratory team resulting in improved transitioning from PICU. Vaginal delivery, Apgar score ≥ 7 at 5 min, and FiO2 < 50% at 24 h increased the likelihood of survival to hospital discharge. © 2022, The Author(s).