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 Purpose 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 W...

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Bibliographic Details
Published in:Journal of pediatric surgery 2015-05, Vol.50 (5), p.849-855
Main Authors: Cauley, Ryan P, Potanos, Kristina, Fullington, Nora, Bairdain, Sigrid, Sheils, Catherine A, Finkelstein, Jonathan A, Graham, Dionne A, Wilson, Jay M
Format: Article
Language:English
Subjects:
Child, Preschool
Congenital anomaly
Extracorporeal membrane oxygenation
Female
Follow-Up Studies
Hernias, Diaphragmatic, Congenital - epidemiology
Hernias, Diaphragmatic, Congenital - therapy
Humans
Infant
Infant, Newborn
Male
Massachusetts - epidemiology
Mechanical ventilation
Morbidity - trends
Pediatrics
Prognosis
Respiration, Artificial - methods
Risk assessment
Surgery
Survival Rate - trends
Survivors
Time Factors
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Summary:Abstract Purpose 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 5 years 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. Conclusion 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.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2014.12.007