Luke R Putnam1, Matthew T Harting2, Kuojen Tsao1, Francesco Morini3, Bradley A Yoder4, Matías Luco5, Pamela A Lally1, Kevin P Lally1. 1. McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas. 2. McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas; matthew.t.harting@uth.tmc.edu. 3. Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 4. University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah; and. 5. Pontificia Universidad Católica de Chile, Santiago, Chile.
Abstract
BACKGROUND AND OBJECTIVE: Survival for infants with congenital diaphragmatic hernia (CDH) has gradually improved, yet substantial burden of disease remains. Although larger CDH defect sizes increase mortality, the association between defect size and morbidity has not been reported. Our objective was to evaluate the association of defect size with pulmonary, neurologic, and gastrointestinal morbidity at the time of hospital discharge. METHODS: An international, prospective cohort study was performed. Patient demographics, intraoperative defect size, and clinical outcomes were reviewed. The primary outcome was morbidity at the time of discharge, which entailed supplemental oxygen requirement, abnormal neurologic clinical and radiographic findings, gastroesophageal reflux, supplemental nutrition, or pulmonary-, neurologic-, or gastrointestinal-related medications. RESULTS: A total of 3665 patients were included in the study cohort. Overall survival was 70.9%, and 84.0% of survivors were discharged from the hospital (16.0% transferred). Median age at discharge was 38 days (interquartile range [IQR] 23-69) and ranged from 22 (IQR 16-32) days for "A" (smallest) defects to 89 (IQR 64-132) days for "D" (largest) defects (P < .001). Of those discharged from the hospital, 1522 (74.2%) had pulmonary (n = 660, 30.2%), neurologic (n = 446, 20.4%), or gastrointestinal (n = 1348, 61.7%) morbidities, and multiple morbidities were diagnosed in 701 (34.7%) patients. On multivariable regression analyses incorporating key patient characteristics, defect size was consistently the greatest predictor of overall morbidity, hospital length of stay, and duration of ventilation. CONCLUSIONS: Infants with CDH are commonly discharged with ≥1 major morbidities. The size of the diaphragmatic defect appears to be the most reliable indicator of a patient's hospital course and discharge burden of disease.
BACKGROUND AND OBJECTIVE: Survival for infants with congenital diaphragmatic hernia (CDH) has gradually improved, yet substantial burden of disease remains. Although larger CDH defect sizes increase mortality, the association between defect size and morbidity has not been reported. Our objective was to evaluate the association of defect size with pulmonary, neurologic, and gastrointestinal morbidity at the time of hospital discharge. METHODS: An international, prospective cohort study was performed. Patient demographics, intraoperative defect size, and clinical outcomes were reviewed. The primary outcome was morbidity at the time of discharge, which entailed supplemental oxygen requirement, abnormal neurologic clinical and radiographic findings, gastroesophageal reflux, supplemental nutrition, or pulmonary-, neurologic-, or gastrointestinal-related medications. RESULTS: A total of 3665 patients were included in the study cohort. Overall survival was 70.9%, and 84.0% of survivors were discharged from the hospital (16.0% transferred). Median age at discharge was 38 days (interquartile range [IQR] 23-69) and ranged from 22 (IQR 16-32) days for "A" (smallest) defects to 89 (IQR 64-132) days for "D" (largest) defects (P < .001). Of those discharged from the hospital, 1522 (74.2%) had pulmonary (n = 660, 30.2%), neurologic (n = 446, 20.4%), or gastrointestinal (n = 1348, 61.7%) morbidities, and multiple morbidities were diagnosed in 701 (34.7%) patients. On multivariable regression analyses incorporating key patient characteristics, defect size was consistently the greatest predictor of overall morbidity, hospital length of stay, and duration of ventilation. CONCLUSIONS:Infants with CDH are commonly discharged with ≥1 major morbidities. The size of the diaphragmatic defect appears to be the most reliable indicator of a patient's hospital course and discharge burden of disease.
Authors: Duy T Dao; Lystra P Hayden; Terry L Buchmiller; Virginia S Kharasch; Ali Kamran; Charles J Smithers; Samuel E Rice-Townsend; Jill M Zalieckas; Ronald Becker; Donna Morash; Mollie Studley; Jay M Wilson; Catherine A Sheils Journal: J Pediatr Date: 2019-11-06 Impact factor: 4.406
Authors: Nori Matsunami; Hari Shanmugam; Lisa Baird; Jeff Stevens; Janice L Byrne; Douglas C Barnhart; Carrie Rau; Marcia L Feldkamp; Bradley A Yoder; Mark F Leppert; H Joseph Yost; Luca Brunelli Journal: Birth Defects Res Date: 2018-03-23 Impact factor: 2.344
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: Katinka Weller; Nina C J Peters; Joost van Rosmalen; Suzan C M Cochius-Den Otter; Philip L J DeKoninck; Rene M H Wijnen; Titia E Cohen-Overbeek; Alex J Eggink Journal: Prenat Diagn Date: 2021-07-28 Impact factor: 3.242