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Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study

BACKGROUND: Most studies examining survival of neonates with congenital diaphragmatic hernia (CDH) are in high-income countries. We aimed to describe the management, survival to hospital discharge rate, and factors associated with survival of neonates with unilateral CDH in a middle-income country....

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Autores principales: Lum, Lucy Chai See, Ramanujam, Tindivanum Muthurangam, Yik, Yee Ian, Lee, Mei Ling, Chuah, Soo Lin, Breen, Emer, Zainal-Abidin, Anis Siham, Singaravel, Srihari, Thambidorai, Conjeevaram Rajendrarao, de Bruyne, Jessie Anne, Nathan, Anna Marie, Thavagnanam, Surendran, Eg, Kah Peng, Chan, Lucy, Abdel-Latif, Mohamed E., Gan, Chin Seng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264560/
https://www.ncbi.nlm.nih.gov/pubmed/35799173
http://dx.doi.org/10.1186/s12887-022-03453-5
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author Lum, Lucy Chai See
Ramanujam, Tindivanum Muthurangam
Yik, Yee Ian
Lee, Mei Ling
Chuah, Soo Lin
Breen, Emer
Zainal-Abidin, Anis Siham
Singaravel, Srihari
Thambidorai, Conjeevaram Rajendrarao
de Bruyne, Jessie Anne
Nathan, Anna Marie
Thavagnanam, Surendran
Eg, Kah Peng
Chan, Lucy
Abdel-Latif, Mohamed E.
Gan, Chin Seng
author_facet Lum, Lucy Chai See
Ramanujam, Tindivanum Muthurangam
Yik, Yee Ian
Lee, Mei Ling
Chuah, Soo Lin
Breen, Emer
Zainal-Abidin, Anis Siham
Singaravel, Srihari
Thambidorai, Conjeevaram Rajendrarao
de Bruyne, Jessie Anne
Nathan, Anna Marie
Thavagnanam, Surendran
Eg, Kah Peng
Chan, Lucy
Abdel-Latif, Mohamed E.
Gan, Chin Seng
author_sort Lum, Lucy Chai See
collection PubMed
description BACKGROUND: Most studies examining survival of neonates with congenital diaphragmatic hernia (CDH) are in high-income countries. We aimed to describe the management, survival to hospital discharge rate, and factors associated with survival of neonates with unilateral CDH in a middle-income country. METHODS: We retrospectively reviewed the medical notes of neonates with unilateral CDH admitted to a pediatric intensive care unit (PICU) in a tertiary referral center over a 15-year period, from 2003–2017. We described the newborns’ respiratory care pathways and then compared baseline demographic, hemodynamic, and respiratory indicators between survivors and non-survivors. The primary outcome measure was survival to hospital discharge. RESULTS: Altogether, 120 neonates were included with 43.3% (52/120) diagnosed antenatally. Stabilization occurred in 38.3% (46/120) with conventional ventilation, 13.3% (16/120) with high-frequency intermittent positive-pressure ventilation, and 22.5% (27/120) with high frequency oscillatory ventilation. Surgical repair was possible in 75.0% (90/120). The overall 30-day survival was 70.8% (85/120) and survival to hospital discharge was 66.7% (80/120). Survival to hospital discharge tended to improve over time (p > 0.05), from 56.0% to 69.5% before and after, respectively, a service reorganization. For those neonates who could be stabilized and operated on, 90.9% (80/88) survived to hospital discharge. The commonest post-operative complication was infection, occurring in 43.3%. The median survivor length of stay was 32.5 (interquartile range 18.8–58.0) days. Multiple logistic regression modelling showed vaginal delivery (odds ratio [OR] = 4.8; 95% confidence interval [CI] [1.1–21.67]; p = 0.041), Apgar score [Formula: see text] 7 at 5 min (OR = 6.7; 95% CI [1.2–36.3]; p = 0.028), and fraction of inspired oxygen (FiO(2)) < 50% at 24 h (OR = 89.6; 95% CI [10.6–758.6]; p < 0.001) were significantly associated with improved survival to hospital discharge. CONCLUSIONS: We report a survival to hospital discharge rate of 66.7%. Survival tended to improve over time, reflecting a greater critical volume of cases and multi-disciplinary care with early involvement of the respiratory team resulting in improved transitioning from PICU. Vaginal delivery, Apgar score [Formula: see text] 7 at 5 min, and FiO(2) < 50% at 24 h increased the likelihood of survival to hospital discharge.
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spelling pubmed-92645602022-07-09 Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study Lum, Lucy Chai See Ramanujam, Tindivanum Muthurangam Yik, Yee Ian Lee, Mei Ling Chuah, Soo Lin Breen, Emer Zainal-Abidin, Anis Siham Singaravel, Srihari Thambidorai, Conjeevaram Rajendrarao de Bruyne, Jessie Anne Nathan, Anna Marie Thavagnanam, Surendran Eg, Kah Peng Chan, Lucy Abdel-Latif, Mohamed E. Gan, Chin Seng BMC Pediatr Research BACKGROUND: Most studies examining survival of neonates with congenital diaphragmatic hernia (CDH) are in high-income countries. We aimed to describe the management, survival to hospital discharge rate, and factors associated with survival of neonates with unilateral CDH in a middle-income country. METHODS: We retrospectively reviewed the medical notes of neonates with unilateral CDH admitted to a pediatric intensive care unit (PICU) in a tertiary referral center over a 15-year period, from 2003–2017. We described the newborns’ respiratory care pathways and then compared baseline demographic, hemodynamic, and respiratory indicators between survivors and non-survivors. The primary outcome measure was survival to hospital discharge. RESULTS: Altogether, 120 neonates were included with 43.3% (52/120) diagnosed antenatally. Stabilization occurred in 38.3% (46/120) with conventional ventilation, 13.3% (16/120) with high-frequency intermittent positive-pressure ventilation, and 22.5% (27/120) with high frequency oscillatory ventilation. Surgical repair was possible in 75.0% (90/120). The overall 30-day survival was 70.8% (85/120) and survival to hospital discharge was 66.7% (80/120). Survival to hospital discharge tended to improve over time (p > 0.05), from 56.0% to 69.5% before and after, respectively, a service reorganization. For those neonates who could be stabilized and operated on, 90.9% (80/88) survived to hospital discharge. The commonest post-operative complication was infection, occurring in 43.3%. The median survivor length of stay was 32.5 (interquartile range 18.8–58.0) days. Multiple logistic regression modelling showed vaginal delivery (odds ratio [OR] = 4.8; 95% confidence interval [CI] [1.1–21.67]; p = 0.041), Apgar score [Formula: see text] 7 at 5 min (OR = 6.7; 95% CI [1.2–36.3]; p = 0.028), and fraction of inspired oxygen (FiO(2)) < 50% at 24 h (OR = 89.6; 95% CI [10.6–758.6]; p < 0.001) were significantly associated with improved survival to hospital discharge. CONCLUSIONS: We report a survival to hospital discharge rate of 66.7%. Survival tended to improve over time, reflecting a greater critical volume of cases and multi-disciplinary care with early involvement of the respiratory team resulting in improved transitioning from PICU. Vaginal delivery, Apgar score [Formula: see text] 7 at 5 min, and FiO(2) < 50% at 24 h increased the likelihood of survival to hospital discharge. BioMed Central 2022-07-07 /pmc/articles/PMC9264560/ /pubmed/35799173 http://dx.doi.org/10.1186/s12887-022-03453-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Lum, Lucy Chai See
Ramanujam, Tindivanum Muthurangam
Yik, Yee Ian
Lee, Mei Ling
Chuah, Soo Lin
Breen, Emer
Zainal-Abidin, Anis Siham
Singaravel, Srihari
Thambidorai, Conjeevaram Rajendrarao
de Bruyne, Jessie Anne
Nathan, Anna Marie
Thavagnanam, Surendran
Eg, Kah Peng
Chan, Lucy
Abdel-Latif, Mohamed E.
Gan, Chin Seng
Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study
title Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study
title_full Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study
title_fullStr Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study
title_full_unstemmed Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study
title_short Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study
title_sort outcomes of neonatal congenital diaphragmatic hernia in a non-ecmo center in a middle-income country: a retrospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264560/
https://www.ncbi.nlm.nih.gov/pubmed/35799173
http://dx.doi.org/10.1186/s12887-022-03453-5
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