Laura E Hollinger1, Pamela A Lally2, KuoJen Tsao3, Curtis J Wray4, Kevin P Lally2. 1. Department of Surgery, The Methodist Hospital and Research Institute, Houston, TX; The Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. 2. The Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. 3. The Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. Electronic address: KuoJenTsao@uth.tmc.edu. 4. The Department of Surgery, The University of Texas School of Medicine at Houston, TX.
Abstract
BACKGROUND: Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns and, despite improved outcomes with multimodality therapies, optimal timing of repair remains undefined. We sought to evaluate the influence of surgical timing on patient outcomes and hypothesized that delayed repair does not improve survival in CDH. METHODS: Prospectively collected data from 1,385 CDH Registry infants without preoperative extracorporeal membrane oxygen therapy (ECMO) were evaluated. Patients were stratified by timing of repair: Day of life (DOL) 0-3 (group 1), 4-7 (group 2), or >8 (group 3), and the effect of surgical timing on mortality was determined by logistic regression and risk-adjusted for severity of illness. RESULTS: The unadjusted odds ratio (OR) for mortality increased significantly with delayed repair (group 2, 1.73 [95% CI, 1.00-2.98; group 3, 3.42 [95% CI, 1.97-5.96]). However, when adjusted for severity of illness, delay in repair did not predict increased mortality (group 2, 1.2 [95% CI, 0.7-2.2]; group 3, 1.4 [95% CI, 0.8-2.6]), nor did it portend an increased need for postoperative ECMO (group 2, 1.1 [95% CI, 0.5-2.4]; group 3, 0.5 [95% CI, 0.2-1.4]). CONCLUSION: After adjustment for known risk factors, the timing of CDH repair in low-risk infants does not seem to influence mortality. However, specific clinical parameters guiding timing of elective CDH repair remain unknown.
BACKGROUND:Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns and, despite improved outcomes with multimodality therapies, optimal timing of repair remains undefined. We sought to evaluate the influence of surgical timing on patient outcomes and hypothesized that delayed repair does not improve survival in CDH. METHODS: Prospectively collected data from 1,385 CDH Registry infants without preoperative extracorporeal membrane oxygen therapy (ECMO) were evaluated. Patients were stratified by timing of repair: Day of life (DOL) 0-3 (group 1), 4-7 (group 2), or >8 (group 3), and the effect of surgical timing on mortality was determined by logistic regression and risk-adjusted for severity of illness. RESULTS: The unadjusted odds ratio (OR) for mortality increased significantly with delayed repair (group 2, 1.73 [95% CI, 1.00-2.98; group 3, 3.42 [95% CI, 1.97-5.96]). However, when adjusted for severity of illness, delay in repair did not predict increased mortality (group 2, 1.2 [95% CI, 0.7-2.2]; group 3, 1.4 [95% CI, 0.8-2.6]), nor did it portend an increased need for postoperative ECMO (group 2, 1.1 [95% CI, 0.5-2.4]; group 3, 0.5 [95% CI, 0.2-1.4]). CONCLUSION: After adjustment for known risk factors, the timing of CDH repair in low-risk infants does not seem to influence mortality. However, specific clinical parameters guiding timing of elective CDH repair remain unknown.
Authors: David W Kays; Saleem Islam; Joy M Perkins; Shawn D Larson; Janice A Taylor; James L Talbert Journal: J Pediatr Surg Date: 2015-03-14 Impact factor: 2.545
Authors: Augusto Zani; Wendy K Chung; Jan Deprest; Matthew T Harting; Tim Jancelewicz; Shaun M Kunisaki; Neil Patel; Lina Antounians; Pramod S Puligandla; Richard Keijzer Journal: Nat Rev Dis Primers Date: 2022-06-01 Impact factor: 52.329
Authors: Kim Heiwegen; Arno Fj van Heijst; Horst Daniels-Scharbatke; Michelle Cp van Peperstraten; Ivo de Blaauw; Sanne Mbi Botden Journal: Eur J Pediatr Date: 2020-01-22 Impact factor: 3.183