Prematurity as a predictor of mortality in infants with isolated congenital diaphragmatic hernia: a single center's experience

Publication Number: .441

Young Mi Park, Gangneung Asan Hospital, College of Ulsan, Gangneung-si, Kangwon-do, Republic of Korea; Byong Sop Lee, University of Ulsan College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Hyunseung Jin, Gangneung Asan Hospital, college of Ulsan, Gangneung si, Kangwon-do, Republic of Korea; Euiseok Jung, Asan Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Jiyoon Jeong, Asan Medical Center Children's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background: Although prematurity is one of the major risk factors for mortality and morbidities in neonatal diseases, it remains unclear whether gestational age (GA) independently increases the risk of mortality in newborn infants with congenital diaphragmatic hernia (CDH).

Objective: The aim of our study was to determine the GA cut-off that affects the clinical outcome of CDH and to identify if the predictive power of fetal lung volume measure is influenced by prematurity.

Design/Methods: We retrospectively reviewed the medical records of newborn infants with isolated CDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the observed to expected lung to head ratio (O/E LHR), between the term infants (TCDH) and the preterm infants (PCDH).

Results: A total of 23 (15.9%) of 145 patients with CDH were preterm infants. The mean O/E LHR was significantly higher in the survivors than the non-survivors (59.3±16.3 vs 36.8±10.8, P< 0.0001), but did not differ between the TCDH and the PCDH group (54.1±18.0 vs 54.1±18.0, P=0.995). There were no differences in the mortality (22.1% vs 30.4%, P=0.389) and the ECMO requirement (19.7% vs 13.0%, P=0.454) between the TCDH and the PCDH group. The mortality rate increased with decreasing gestational age, and was significantly higher in infants with GA < 34 weeks (80%) than in late preterm infants (16.7%) (P=0.006). In multivariate analyses, O/E LHR (adjusted OR 0.872 [95% CI 0.827-0.920], P< 0.0001) was a risk factor predicting mortality, but GA < 34 weeks was not (adjusted OR 14.340 [95% CI 0.446-460.803], P=0.133). The predictive power of O/E LHR was excellent both in the TCDH group (AUC 0.876, 95% CI 0.799-0.952, P< 0.0001) and PCDH group (AUC 0.927, 95% CI 0.805-1.000, P=0.003).
Conclusion(s): he O/E LHR value was a strong predictor for mortality in preterm infants. Preterm birth itself should not be considered as a variable that determines the early treatment strategy of CDH.

Neonatal outcomes between the TCDH and the PCDH group.There were no differences in the mortality (22.1% vs 30.4%, P=0.389) and the ECMO requirement (19.7% vs 13.0%, P=0.454) between the TCDH and the PCDH group.
Survival rate by gestational ageThe mortality rate increased with decreasing gestational age, and was significantly higher in infants with GA < 34 weeks (80%) than in late preterm infants (16.7%) (P=0.006)