Congenital diaphragmatic hernia: outcomes of neonates treated at Mayo Clinic with and without extracorporeal membrane oxygenation
| Autor: | Ruža Grizelj, Toby N. Weingarten, Gregory J. Schears, Alexandre N. Cavalcante, Darrell R. Schroeder, William A. Carey, Katarina Bojanić, Garth F. Asay, Christopher E. Colby, Jason M. Woodbury, Juraj Sprung |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cohort Studies 03 medical and health sciences Pulmonary hypoplasia 0302 clinical medicine Extracorporeal Membrane Oxygenation Interquartile range 030225 pediatrics Extracorporeal membrane oxygenation Odds Ratio Medicine Humans Retrospective Studies 030219 obstetrics & reproductive medicine business.industry Infant Newborn Congenital diaphragmatic hernia Retrospective cohort study Odds ratio medicine.disease Survival Analysis Surgery Bochdalek hernia Anesthesiology and Pain Medicine Treatment Outcome Anesthesia Pediatrics Perinatology and Child Health Failure to thrive gastroesophageal reflux disease mortality pulmonary hypertension pulmonary hypoplasia survival Female medicine.symptom business Hernias Diaphragmatic Congenital |
| Zdroj: | Paediatric anaesthesia. 27(3) |
| ISSN: | 1460-9592 |
| Popis: | SummaryBackground Congenital diaphragmatic hernia (CDH) is a rare anomaly with high mortality and long-term comorbid conditions. Aims Our aim was to describe the presenting characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution. Methods We performed a retrospective cohort study and identified consecutive neonates treated for CDH from 2001 to 2015 at our institution. For all patients identified, we reviewed hospital and postdischarge data for neonatal, disease, and treatment characteristics. We determined hospital survival overall and also according to the presence of prenatal diagnosis, liver herniation into the chest (liver up), and the use of extracorporeal membrane oxygenation (ECMO) in addition to surgery. We evaluated postdischarge chronic conditions in patients with at least one year of follow-up. Results Thirty-eight neonates were admitted for treatment during the study period. In three who were in extremis, life support was withdrawn. The other 35 underwent surgical repair, of whom eight received ECMO. The overall survival was 79% (30/38). Survival for those who had surgical correction of CDH but did not need ECMO was 89% (24/27); it was 75% (6/8) for those who received ECMO and had surgery. Hospital survival was lower for liver-up vs liver-down CDH (61% [11/18] vs 95% [19/20]; odds ratio, 0.08; 95% CI, 0.01–0.77; P = 0.01). Among survivors, the median duration of hospitalization was 31 (interquartile range, 20–73) days. Major chronic pulmonary and gastrointestinal disorders, failure to thrive, and neurodevelopmental delays were the most noted comorbid conditions after discharge, and all were more prevalent in those who required ECMO. Conclusion The overall survival of neonates with CDH was 79%. Intrathoracic liver herniation was associated with more frequent use of ECMO and greater mortality. A substantial number of survivors, especially those who required ECMO, experienced chronic conditions after discharge. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text