Alexey Abramov1, Weijia Fan2, Rebecca Hernan3, Ariela L Zenilman4, Julia Wynn3, Gudrun Aspelund4, Julie Khlevner3, Usha Krishnan3, Foong-Yen Lim5, George B Mychaliska6, Brad W Warner7, Robert Cusick8, Timothy Crombleholme5, Dai Chung9, Melissa E Danko9, Amy J Wagner10, Kenneth Azarow11, David Schindel12, Douglas Potoka13, Sam Soffer14, Jason Fisher15, David McCulley16, Christiana Farkouh-Karoleski3, Wendy K Chung17, Vincent Duron4. 1. Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA. Electronic address: aa3832@cumc.columbia.edu. 2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. 3. Department of Pediatrics, Columbia University Medical Center, New York, NY, USA. 4. Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA. 5. Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 6. Section of Pediatric Surgery, Fetal Diagnosis and Treatment Center, University of Michigan Health System, Ann Arbor, MI, USA. 7. Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO, USA. 8. Division of Pediatric Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA. 9. Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. 10. Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA. 11. Pediatric Surgery Division, Department of Surgery, Oregon Health & Science University, Portland, OR, USA. 12. Division of Pediatric Surgery, UT Southwestern Medical Center, Dallas, TX, USA. 13. Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. 14. Department of Pediatric Surgery, Northwell Health, New York, NY, USA. 15. Division of Pediatric Surgery, New York University Langone Medical Center, New York, NY, USA. 16. Department of Pediatrics, Meriter-Unity Point Health, Madison, WI, USA. 17. Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Department of Medicine, Columbia University Medical Center, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
Abstract
BACKGROUND: Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500-3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH). METHODS: We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH. RESULTS: A total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p=0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p=0.022) and a higher frequency of need for oxygen at discharge (p=0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence. CONCLUSION: In this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair. TYPE OF STUDY: Prognosis study LEVEL OF EVIDENCE: Level II.
BACKGROUND:Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500-3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH). METHODS: We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH. RESULTS: A total of 588, 495 L-CDH, and 93 R-CDHpatients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p=0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p=0.022) and a higher frequency of need for oxygen at discharge (p=0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence. CONCLUSION: In this large series comparing R to L-CDHpatients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair. TYPE OF STUDY: Prognosis study LEVEL OF EVIDENCE: Level II.
Authors: Andrew Wardley; Javier Cortes; Louise Provencher; Kathy Miller; A Jo Chien; Hope S Rugo; Joyce Steinberg; Jennifer Sugg; Iulia C Tudor; Manon Huizing; Robyn Young; Vandana Abramson; Ron Bose; Lowell Hart; Stephen Chan; David Cameron; Gail S Wright; Marie-Pascale Graas; Patrick Neven; Andrea Rocca; Stefania Russo; Ian E Krop Journal: Breast Cancer Res Treat Date: 2021-02-16 Impact factor: 4.872
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