Right- versus left-sided congenital diaphragmatic hernia: postnatal outcome at a specialized tertiary care center
Objective: To systematically investigate the impact of the location of the defect in congenital diaphragmatic hernia on neonatal mortality and morbidity with a special focus on survival at discharge, extracorporeal membrane oxygenation requirement, and the development of chronic lung disease., Desig...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
Jan 2012
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| In: |
Pediatric critical care medicine
Year: 2012, Volume: 13, Issue: 1, Pages: 66-71 |
| ISSN: | 1947-3893 |
| DOI: | 10.1097/PCC.0b013e3182192aa9 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1097/PCC.0b013e3182192aa9
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| Author Notes: | Thomas Schaible, MD; Thomas Kohl, MD; Konrad Reinshagen, MD; Joachim Brade, PhD; K. Wolfgang Neff, MD;MD; Rudiger Stressig, MD; Karen A. Büsing, MD |
| Summary: | Objective: To systematically investigate the impact of the location of the defect in congenital diaphragmatic hernia on neonatal mortality and morbidity with a special focus on survival at discharge, extracorporeal membrane oxygenation requirement, and the development of chronic lung disease., Design: Retrospective tertiary care center study with a matched-pair analysis of all fetuses that were treated for congenital diaphragmatic hernia between 2004 and 2009., Setting: A specialized tertiary care center for fetuses with congenital diaphragmatic hernia., Patients: Complete sets of data were available for 106 patients with congenital diaphragmatic hernia. For 17 of 18 infants with right-sided congenital diaphragmatic hernia we were able to allocate infants with left-sided congenital diaphragmatic hernia with no relevant difference in previously described prognostic factors, such as pulmonary hypoplasia and liver herniation., Interventions: None., Measurements and Main Results: There was a strong trend toward better survival in infants with right-sided congenital diaphragmatic hernia than with left-sided congenital diaphragmatic hernia (94% vs. 70%; p = .07). More neonates with left-sided congenital diaphragmatic hernia died of severe pulmonary hypertension despite extracorporeal membrane oxygenation. Fewer neonates with right-sided congenital diaphragmatic hernia died, yet higher degrees of pulmonary hypoplasia and oxygen requirement were observed despite extracorporeal membrane oxygenation., Conclusions: In congenital diaphragmatic hernia, the location of the defect has a substantial impact on postnatal survival and the development of chronic lung disease. In left-sided congenital diaphragmatic hernia, pulmonary hypertension resistant to therapeutic management, including extracorporeal membrane oxygenation, is more common and is associated with a higher rate of neonatal demise. Right-sided congenital diaphragmatic hernia infants have an increased benefit from extracorporeal membrane oxygenation but the better survival entails a higher rate of chronic lung disease., (C)2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies |
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| Item Description: | Gesehen am 10.08.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1947-3893 |
| DOI: | 10.1097/PCC.0b013e3182192aa9 |