Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2012
Right- versus left-sided congenital diaphragmatic hernia: postnatal outcome at a specialized tertiary care center.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Schaible Thomas, Kohl Thomas, Reinshagen Konrad, Brade Joachim, Neff K Wolfgang, Stressig Rüdiger, Büsing Karen A
Аннотация
OBJECTIVE: To systematically investigate the impact of the location of the defect in congenital diaphragmatic hernia on neonatal mortality and morbidity with a special focus on survival at discharge, extracorporeal membrane oxygenation requirement, and the development of chronic lung disease.
DESIGN: Retrospective tertiary care center study with a matched-pair analysis of all fetuses that were treated for congenital diaphragmatic hernia between 2004 and 2009.
SETTING: A specialized tertiary care center for fetuses with congenital diaphragmatic hernia.
PATIENTS: Complete sets of data were available for 106 patients with congenital diaphragmatic hernia. For 17 of 18 infants with right-sided congenital diaphragmatic hernia we were able to allocate infants with left-sided congenital diaphragmatic hernia with no relevant difference in previously described prognostic factors, such as pulmonary hypoplasia and liver herniation.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: There was a strong trend toward better survival in infants with right-sided congenital diaphragmatic hernia than with left-sided congenital diaphragmatic hernia (94% vs. 70%; p = .07). More neonates with left-sided congenital diaphragmatic hernia died of severe pulmonary hypertension despite extracorporeal membrane oxygenation. Fewer neonates with right-sided congenital diaphragmatic hernia died, yet higher degrees of pulmonary hypoplasia and oxygen requirement were observed despite extracorporeal membrane oxygenation.
CONCLUSIONS: In congenital diaphragmatic hernia, the location of the defect has a substantial impact on postnatal survival and the development of chronic lung disease. In left-sided congenital diaphragmatic hernia, pulmonary hypertension resistant to therapeutic management, including extracorporeal membrane oxygenation, is more common and is associated with a higher rate of neonatal demise. Right-sided congenital diaphragmatic hernia infants have an increased benefit from extracorporeal membrane oxygenation but the better survival entails a higher rate of chronic lung disease.
DESIGN: Retrospective tertiary care center study with a matched-pair analysis of all fetuses that were treated for congenital diaphragmatic hernia between 2004 and 2009.
SETTING: A specialized tertiary care center for fetuses with congenital diaphragmatic hernia.
PATIENTS: Complete sets of data were available for 106 patients with congenital diaphragmatic hernia. For 17 of 18 infants with right-sided congenital diaphragmatic hernia we were able to allocate infants with left-sided congenital diaphragmatic hernia with no relevant difference in previously described prognostic factors, such as pulmonary hypoplasia and liver herniation.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: There was a strong trend toward better survival in infants with right-sided congenital diaphragmatic hernia than with left-sided congenital diaphragmatic hernia (94% vs. 70%; p = .07). More neonates with left-sided congenital diaphragmatic hernia died of severe pulmonary hypertension despite extracorporeal membrane oxygenation. Fewer neonates with right-sided congenital diaphragmatic hernia died, yet higher degrees of pulmonary hypoplasia and oxygen requirement were observed despite extracorporeal membrane oxygenation.
CONCLUSIONS: In congenital diaphragmatic hernia, the location of the defect has a substantial impact on postnatal survival and the development of chronic lung disease. In left-sided congenital diaphragmatic hernia, pulmonary hypertension resistant to therapeutic management, including extracorporeal membrane oxygenation, is more common and is associated with a higher rate of neonatal demise. Right-sided congenital diaphragmatic hernia infants have an increased benefit from extracorporeal membrane oxygenation but the better survival entails a higher rate of chronic lung disease.
Предметные рубрики MeSH
Case-Control StudiesExtracorporeal Membrane OxygenationFemaleFetal DiseasesFollow-Up StudiesHernia, DiaphragmaticHernias, Diaphragmatic, CongenitalHumansInfant, NewbornMagnetic Resonance ImagingMalePostoperative ComplicationsPregnancyPrenatal DiagnosisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSurvival AnalysisThoracoscopyTreatment Outcome