title: Risk factors for the recurrence of the congenital diaphragmatic hernia-report from the long-term follow-up study of Japanese CDH study group.
abstract: OBJECTIVE
  Few follow-up studies focused on the recurrence regarding the postoperative course of congenital diaphragmatic hernia (CDH) survivors. The aim of this study was to report on risk factor for CDH patients who had the recurrence during the follow-up.
  
  
  METHODS
  A multicenter retrospective survey was conducted on neonates diagnosed to have CDH between January 2006 and December 2010. Follow-up survey was conducted between September 2013 and October 2013 (ethical approval: No. 25-222). Nine institutions agreed to participate in this survey. Out of 228, 182 (79.8%) patients were alive and 180 patients were included in this study. Two patients were excluded because the defect had not repaired at the primary operation. The patients were divided into the recurrence group (n=21) and the nonrecurrence group (n=159). Postnatal and postoperative variables were compared between these two groups. Baseline variables which showed significance in univariate analysis were entered into multiple logistic regression analysis for analyzing the recurrence. A value of p<0.05 was considered to be statistically significant by using the JMP software program (version 9; SAS Institute, Inc, Cary, North Carolina, United States).
  
  
  RESULTS
  Out of 180, 21 (11.7%) CDH neonates had the recurrence during the course of the follow-up. Five (2.8%) patients had the recurrence before primary discharge and 16 (8.9%) patients had the recurrence after discharge. Univariate analysis showed that liver herniation (crude odds ratio [OR], 7.4; 95% confidence interval [CI], 2.73-23.68), defect size C and D, proposed by the CDH Study Group (crude OR, 7.09; 95% CI, 2.73-19.99) and patch repair (crude OR, 5.00; 95% CI, 1.91-14.70) were risk factors. Multivariate logistic regression analysis showed liver herniation (adjusted OR, 3.96; 95% CI, 1.01-16.92) was the risk factor for the recurrence.
  
  
  CONCLUSIONS
  A wide spectrum of the disease severity and the rarity of the disease mask the risk of the recurrence for CDH patients. This study showed the only factor to predict the recurrence was the liver herniation. These data will be helpful for providing information for the long-term follow-up of the CDH patients.
authors.affiliation: Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Usui
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Terui
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Takayasu
authors.affiliation: Division of Neonatology, Department of Maternal and Perinatal Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Goishi
authors.affiliation: Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hayakawa
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tazuke
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Yokoi
authors.affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.affiliation: Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index