Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery.
OBJECTIVE
Controversy persists regarding the factors influencing survival in patients with congenital diaphragmatic hernia (CDH), in particular, the role of timing of surgery. The authors therefore sought to determine such factors and to assess the relative role of timing of surgery on outcome.


METHODS
All CDH newborns 1991 through 2002 (n = 111) were divided into those undergoing repair before ("early" n = 35), or after ("late" n = 76) 48 hours. A multivariate analysis was performed to determine the relative impact of various factors on survival rate.


RESULTS
Overall survival rate was 64%. There was no effect on survival of heart rate, temperature, systolic blood pressure, age, extracorporeal membrane oxygenation use, mesh use, infections, or intracranial hemorrhage, and there was no difference between early (68%) or late (62%) repair (P =.2). Initial pCO2 greater than 50, pO2 less than 40, cardiac defects, or renal failure significantly decreased survival rate.


CONCLUSIONS
Significant factors influencing survival rate in patients with CDH include cardiac defects, renal failure, and the initial blood gases and not the timing of surgery. CDH repair should be based on the optimization of clinical parameters as opposed to a specific time period to improve outcome.
Rozmiarek
Andrew J
AJ
Division of Pediatric Surgery, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, USA.
Qureshi
Faisal G
FG
Cassidy
Laura
L
Ford
Henri R
HR
Hackam
David J
DJ
D000015:Abnormalities, Multiple / Q000453:epidemiology; D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D001724:Birth Weight; D002245:Carbon Dioxide / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000097:blood / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006935:Hypercapnia / Q000209:etiology; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016019:Survival Analysis; D013997:Time Factors
D002245:Carbon Dioxide; D010100:Oxygen