title: Congenital Diaphragmatic Hernia Defect Size and Infant Morbidity at Discharge.
abstract: Survival for infants with congenital diaphragmatic hernia (CDH) has gradually improved, yet substantial burden of disease remains. Although larger CDH defect sizes increase mortality, the association between defect size and morbidity has not been reported. Our objective was to evaluate the association of defect size with pulmonary, neurologic, and gastrointestinal morbidity at the time of hospital discharge.
  
  
  
  An international, prospective cohort study was performed. Patient demographics, intraoperative defect size, and clinical outcomes were reviewed. The primary outcome was morbidity at the time of discharge, which entailed supplemental oxygen requirement, abnormal neurologic clinical and radiographic findings, gastroesophageal reflux, supplemental nutrition, or pulmonary-, neurologic-, or gastrointestinal-related medications.
  
  
  
  A total of 3665 patients were included in the study cohort. Overall survival was 70.9%, and 84.0% of survivors were discharged from the hospital (16.0% transferred). Median age at discharge was 38 days (interquartile range [IQR] 23-69) and ranged from 22 (IQR 16-32) days for "A" (smallest) defects to 89 (IQR 64-132) days for "D" (largest) defects (P < .001). Of those discharged from the hospital, 1522 (74.2%) had pulmonary (n = 660, 30.2%), neurologic (n = 446, 20.4%), or gastrointestinal (n = 1348, 61.7%) morbidities, and multiple morbidities were diagnosed in 701 (34.7%) patients. On multivariable regression analyses incorporating key patient characteristics, defect size was consistently the greatest predictor of overall morbidity, hospital length of stay, and duration of ventilation.
  
  
  
  Infants with CDH are commonly discharged with ≥1 major morbidities. The size of the diaphragmatic defect appears to be the most reliable indicator of a patient's hospital course and discharge burden of disease.
authors.affiliation: McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas; matthew.t.harting@uth.tmc.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Harting
authors.affiliation: McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Kuojen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Morini
authors.affiliation: University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah; and.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.affiliation: Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Matías
authors.initials: M
authors.lastname: Luco
authors.affiliation: McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lally
authors.affiliation: McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy; D003266:Continuity of Patient Care; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000401:mortality / Q000503:physiopathology*; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038622:Internationality; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D017741:Survivors