François Barrière1, Fabrice Michel2, Anderson D Loundou3, Virginie Fouquet4, Elsa Kermorvant5, Sébastien Blanc6, Elisabeth Carricaburu7, Amélie Desrumaux8, Odile Pidoux9, Alexis Arnaud10, Nicolas Berte11, Thierry Blanc12, Frederic Lavrand13, Guillaume Levard14, Isabelle Rayet15, Sylvain Samperiz16, Anne Schneider17, Marie-Odile Marcoux18, Norbert Winer19, Yann Chaussy20, Valérie Datin-Dorriere21, Quentin Ballouhey22, Aurélien Binet23, Charles Muszynski24, Jean Breaud25, Armelle Garenne26, Laurent Storme27, Julia Boubnova28. 1. Pediatric Intensive Care Unit, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. Electronic address: francois.barriere@gmail.com. 2. Pediatric Intensive Care Unit, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 3. Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 4. Department of Pediatric Surgery, Paris South University Hospitals, AP-HP, Le Kremlin-Bicêtre, France. 5. Neonatal Intensive Care Unit, Necker-Enfants Malades, AP-HP, Paris Descartes University, Paris, France. 6. Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France. 7. Department of Pediatric Surgery, Robert-Debré Hospital, AP-HP, Paris, France. 8. Neonatal Intensive Care Unit, Couple-Enfant Hospital, Grenoble, France. 9. Department of Neonatology, University Hospital, Montpellier, France. 10. Department of Pediatric Surgery, Hôpital Sud, University Hospital, Rennes, France. 11. Department of Surgery, University Hospital, Nancy, France. 12. Neonatal Intensive Care Unit, University Hospital, Rouen, France. 13. Department of Pediatric Surgery, University of Bordeaux, Pellegrin-Enfant Hospital, Bordeaux, France. 14. Department of Pediatric Surgery, University Hospital, Poitiers, France. 15. Neonatal and Pediatric Intensive Care Unit, Hôpital Nord, Saint-Etienne, France. 16. Neonatal and Pediatric Intensive Care Unit, Felix Guyon Hospital, La Réunion, France. 17. Department of Pediatric Surgery, Hautepierre Hospital University Medical Center, Strasbourg, France. 18. Neonatal Intensive Care Unit, Hôpital des Enfants, Toulouse, France. 19. Department of Gynecology and Obstetrics, Hôtel-Dieu University Hospital, Nantes, France. 20. Department of Pediatric Surgery, Jean Minjoz University Hospital, Besançon, France. 21. Neonatal Intensive Care Unit, Côte de Nacre University Hospital, Caen, France. 22. Department of Pediatric Surgery, University Hospital, Limoges, France. 23. Department of Pediatric Surgery, Clocheville University Hospital, Tours, France. 24. Department of Obstetrics and Gynecology, Amiens University Hospital, Amiens, France. 25. Department of Pediatric Surgery, Nice Pediatric Hospital, University of Nice-Sophia Antipolis, Nice, France. 26. Pediatric Department, Brest University Hospital, Brest, France. 27. Department of Neonatal Medicine, Lille University Hospital, Lille, France. 28. Department of Pediatric Surgery, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
Abstract
OBJECTIVE: To evaluate the status of congenital diaphragmatic hernia (CDH) management in France and to assess predictors of adverse outcomes. STUDY DESIGN: We reviewed the first-year outcome of all cases of CDH reported to the French National Register in 2011. RESULTS: A total of 158 cases were included. Of these, 83% (131) were prenatally diagnosed, with a mortality rate of 39% (44 of 112) for live born infants with a known outcome at hospital discharge. Mortality increased to 47% (60 of 128) including those with termination of pregnancy and fetal loss. This contrasts with the 7% (2 of 27) mortality rate of the patients diagnosed postnatally (P = .002). Mortality worsened with 1 prenatal marker of CDH severity (OR 3.38 [1.30-8.83] P = .013) and worsened further with 2 markers (OR 20.64 [5.29-80.62] P < .001). Classic postnatal risk factors of mortality such as side of hernia (nonleft P = .001), prematurity (P < .001), low birth weight (P = .002), and size of the defect (P < .001) were confirmed. Of the 141 live births (114 prenatal and 27 postnatal diagnosis) with known outcomes, 93 (67%) survived to hospital discharge, 68 (60%) with a prenatal diagnosis and 25 (93%) with a postnatal diagnosis. The median time to hospital discharge was 34 days (IQR, 19.25-62). Of these survivors, 71 (76%) were followed up for 1 year. CONCLUSIONS: Despite advances in management of CDH, mortality was high and associated with prenatal risk factors. Postnatally, severe persistent pulmonary hypertension was difficult to predict and presented persistent challenges in management.
OBJECTIVE: To evaluate the status of congenital diaphragmatic hernia (CDH) management in France and to assess predictors of adverse outcomes. STUDY DESIGN: We reviewed the first-year outcome of all cases of CDH reported to the French National Register in 2011. RESULTS: A total of 158 cases were included. Of these, 83% (131) were prenatally diagnosed, with a mortality rate of 39% (44 of 112) for live born infants with a known outcome at hospital discharge. Mortality increased to 47% (60 of 128) including those with termination of pregnancy and fetal loss. This contrasts with the 7% (2 of 27) mortality rate of the patients diagnosed postnatally (P = .002). Mortality worsened with 1 prenatal marker of CDH severity (OR 3.38 [1.30-8.83] P = .013) and worsened further with 2 markers (OR 20.64 [5.29-80.62] P < .001). Classic postnatal risk factors of mortality such as side of hernia (nonleft P = .001), prematurity (P < .001), low birth weight (P = .002), and size of the defect (P < .001) were confirmed. Of the 141 live births (114 prenatal and 27 postnatal diagnosis) with known outcomes, 93 (67%) survived to hospital discharge, 68 (60%) with a prenatal diagnosis and 25 (93%) with a postnatal diagnosis. The median time to hospital discharge was 34 days (IQR, 19.25-62). Of these survivors, 71 (76%) were followed up for 1 year. CONCLUSIONS: Despite advances in management of CDH, mortality was high and associated with prenatal risk factors. Postnatally, severe persistent pulmonary hypertension was difficult to predict and presented persistent challenges in management.
Authors: Duy T Dao; Neil Patel; Matthew T Harting; Kevin P Lally; Pamela A Lally; Terry L Buchmiller Journal: Pediatr Crit Care Med Date: 2020-07 Impact factor: 3.624
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