Kim Heiwegen1, Iris A L M van Rooij2, Arno van Heijst3, Ivo de Blaauw4, Sanne M B I Botden4. 1. Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Kim.Heiwegen@radboudumc.nl. 2. Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands. 3. Department of Neonatology, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands. 4. Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Abstract
INTRODUCTION: Several medical and surgical improvements in the treatment of congenital diaphragmatic hernia (CDH) patients have led to a higher survival rate. However, some of these improvements also lead to an increased morbidity rate. This study aims to determine the contribution different medical and surgical treatments have had on the development of surgical complications. METHOD: All CDH patients treated in a single centre between 2000 and 2015 were retrospectively evaluated. Multivariate logistic regression was used to estimate the independent effects of several treatment options that could influence the surgical outcome by adjustment for multiple risk factors. RESULTS: Sixty of the 197 surgically repaired CDH patients had surgical complications. There were more haemorrhagic complications in the ECMO compared to non-ECMO group (27% vs. 2%, p < 0.001). The use of inhaled nitric oxide was also significantly related to haemorrhage (OR = 13.0 (95% CI 1.1-159)). After adjustment for other risk factors, chylothorax was neither significantly associated with ECMO treatment (OR = 1.6 (95% CI 0.5-5.2) nor with patch repair (OR = 2.1: 95% CI 0.7-6.1). A recurrence occurred more often in patients with pulmonary hypertension (OR = 10.0 (95% CI 1.5-65.8) and after treatment with an abdominal patch (OR = 11.3: 95% CI 1.5-84.4). CONCLUSION: ECMO treatment and the inhalation of nitric oxide are used in the most severe CDH patients but are associated with a higher risk on surgical haemorrhage. The recurrence rate is associated with both the use of an abdominal patch and the presence of pulmonary hypertension, regardless of medical treatment.
INTRODUCTION: Several medical and surgical improvements in the treatment of congenital diaphragmatic hernia (CDH) patients have led to a higher survival rate. However, some of these improvements also lead to an increased morbidity rate. This study aims to determine the contribution different medical and surgical treatments have had on the development of surgical complications. METHOD: All CDHpatients treated in a single centre between 2000 and 2015 were retrospectively evaluated. Multivariate logistic regression was used to estimate the independent effects of several treatment options that could influence the surgical outcome by adjustment for multiple risk factors. RESULTS: Sixty of the 197 surgically repaired CDHpatients had surgical complications. There were more haemorrhagic complications in the ECMO compared to non-ECMO group (27% vs. 2%, p < 0.001). The use of inhaled nitric oxide was also significantly related to haemorrhage (OR = 13.0 (95% CI 1.1-159)). After adjustment for other risk factors, chylothorax was neither significantly associated with ECMO treatment (OR = 1.6 (95% CI 0.5-5.2) nor with patch repair (OR = 2.1: 95% CI 0.7-6.1). A recurrence occurred more often in patients with pulmonary hypertension (OR = 10.0 (95% CI 1.5-65.8) and after treatment with an abdominal patch (OR = 11.3: 95% CI 1.5-84.4). CONCLUSION: ECMO treatment and the inhalation of nitric oxide are used in the most severe CDHpatients but are associated with a higher risk on surgical haemorrhage. The recurrence rate is associated with both the use of an abdominal patch and the presence of pulmonary hypertension, regardless of medical treatment.
Authors: I Reiss; T Schaible; L van den Hout; I Capolupo; K Allegaert; A van Heijst; M Gorett Silva; A Greenough; D Tibboel Journal: Neonatology Date: 2010-10-27 Impact factor: 4.035
Authors: Stan Janssen; Kim Heiwegen; Iris Alm van Rooij; Horst Scharbatke; Jolt Roukema; Ivo de Blaauw; Sanne Mbi Botden Journal: J Pediatr Surg Date: 2017-06-03 Impact factor: 2.545
Authors: Luke R Putnam; Kuojen Tsao; Francesco Morini; Pamela A Lally; Charles C Miller; Kevin P Lally; Matthew T Harting Journal: JAMA Pediatr Date: 2016-12-01 Impact factor: 16.193
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Authors: Katrin B Zahn; Thomas Schaible; Neysan Rafat; Meike Weis; Christel Weiss; Lucas Wessel Journal: Front Pediatr Date: 2021-12-17 Impact factor: 3.418