Neonatal Med.  2022 May;29(2):76-83. 10.5385/nm.2022.29.2.76.

Perinatal Prognostic Factors for Congenital Diaphragmatic Hernia: A Korean Single-Center Study

• Jeon S
• Jeong MH
• Jeong SH
• Park SJ
• Lee N
• Bae MH
• Park KH
• Byun SY
• Kim SH
• Cho YH
• Kim C
• Han YM

• KMID: 2530610
• DOI: http://doi.org/10.5385/nm.2022.29.2.76

Abstract

Purpose
This study aimed to identify prognostic factors based on treatment outcomes for congenital diaphragmatic hernia (CDH) at a single-center and to identify factors that may improve these outcomes.
Methods
Thirty-five neonates diagnosed with CDH between January 2011 and December 2021 were retrospectively analyzed. Pre- and postnatal factors were correlated and analyzed with postnatal clinical outcomes to determine the prognostic factors. Highest oxygenation index (OI) within 24 hours of birth was also calculated. Treatment strategy and outcome analysis of published literatures were also performed.
Results
Overall survival rate of this cohort was 60%. Four patients were unable to undergo anesthesia and/or surgery. Three patients who commenced extracorporeal membrane oxygenation (ECMO) post-surgery were non-survivors. Compared to the survivor group, the non-survivor group had a significantly higher occurrence of pneumothorax on the first day, need for high-frequency ventilator and inhaled nitric oxide use, and high OI within the first 24 hours. The non-survivor group showed an early trend towards the surgery timing and a greater number of patch closures. Area under the receiver operating characteristic curve was 0.878 with a sensitivity of 76.2% and specificity of 92.9% at an OI cutoff value of 7.75.
Conclusion
OI within 24 hours is a valuable predictor of survival. It is expected that the application of ECMO based on OI monitoring may help improve the opportunity for surgical repair, as well as the prognosis of CDH patients.

Keyword

Hernias, diaphragmatic, congenital; Mortality; Oxygen; Prognosis

Figure

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  Figure 1. Area under the receiver operating characteristic curve (AUC) of the highest preoperative oxygenation index within 24 hours of birth.

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