title: Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Pulmonary support (PS) on day-of-life-30 (DOL-30) has been shown to be the strongest predictor of subsequent morbidity and in-patient mortality in congenital diaphragmatic hernia (CDH). We hypothesized that PS on DOL-30 can also predict long-term outcomes in CDH survivors.
  
  
  METHODS
  We analyzed records of 201 CDH survivors followed by a single multidisciplinary clinic (1995-2010). Follow-up was 83 and 70% at 1 and 5years respectively. PS was defined as: (1) invasive support (n=44), (2) noninvasive support (n=54), or (3) room air (n=103). Logistic regression was used to estimate the adjusted association of PS on DOL-30 with outcomes at 1 and 5-years.
  
  
  RESULTS
  Use of PS on DOL-30 was significantly associated with pulmonary and developmental morbidities at 1 and 5-years. Even after adjusting for defect-size and presence of ventilation/perfusion mismatch, greater PS on DOL-30 was associated with a significantly increased odds of requiring supplemental oxygen and developmental referral at 1-year, and asthma and developmental referral at 5-years.
  
  
  CONCLUSIONS
  CDH survivors continue to have significant long-term pulmonary and developmental morbidities. PS on DOL-30 is a strong independent predictor of morbidity at 1 and 5-years and may be used as a simple prognostic tool to identify high-risk infants.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Cauley
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Potanos
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Fullington
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sheils
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA. Electronic address: jay.wilson@childrens.harvard.edu.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Wilson
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D017741:Survivors; D013997:Time Factors
keywords: Congenital anomaly; Extracorporeal membrane oxygenation; Mechanical ventilation; Risk assessment