Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia.
BACKGROUND
Congenital diaphragmatic hernia (CDH) is associated with a mortality rate of 10-35% in live-born infants. Moreover, CDH survivors have a substantial risk of developing long-term pulmonary sequelae, such as bronchopulmonary dysplasia (BPD).


OBJECTIVE
This study aims to evaluate risk factors associated with BPD and mortality in neonates with CDH, with particular focus on the initial ventilation mode.


METHODS
Eligible for inclusion were live-born infants with CDH born from 2001 through 2006 at the centers participating in the CDH Study Group. BPD (defined as oxygen dependency at day 30) and/or mortality by day 30 served as the primary endpoint.


RESULTS
A total of 2,078 neonates were included in the analysis. At day 30, 56% of the patients had either died or met the criteria for BPD. In infants who survived until day 30, the prevalence of BPD was 41%. The overall mortality rate was 31%. High-frequency oscillatory ventilation as initial ventilation mode, a right-sided defect, a prenatal diagnosis, a lower Apgar score at 5 min, a cardiac anomaly, a chromosomal anomaly and a lower gestational age were all associated with BPD and/or mortality by day 30.


CONCLUSIONS
Despite improvements in neonatal care, the rates of BPD and early mortality in newborns with CDH are still considerable. Several important risk factors for a worse outcome are reported in this nonrandomized prospective observational study.
Intensive Care and Department of Pediatric Surgery, Erasmus MC - Sophia, Rotterdam, The Netherlands.
L
L
van den Hout
I
I
Reiss
J F
JF
Felix
W C J
WC
Hop
Pamela A
PA
Lally
Kevin P
KP
Lally
D
D
Tibboel
D001997:Bronchopulmonary Dysplasia / Q000401:mortality*; D002908:Chronic Disease; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality*; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012131:Respiratory Insufficiency / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate