Pulmonary support on day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia

J Pediatr Surg. 2013 Jun;48(6):1183-9. doi: 10.1016/j.jpedsurg.2013.03.012.

Abstract

Purpose: Congenital diaphragmatic hernia (CDH) is associated with significant in-hospital mortality, morbidity and length-of-stay (LOS). We hypothesized that the degree of pulmonary support on hospital day-30 may predict in-hospital mortality, LOS, and discharge oxygen needs and could be useful for risk prediction and counseling.

Methods: 862 patients in the CDH Study Group registry with a LOS ≥ 30 days were analyzed (2007-2010). Pulmonary support was defined as (1) room-air (n=320) (2) noninvasive supplementation (n=244) (3) mechanical ventilation (n=279) and (4) extracorporeal membrane oxygenation (ECMO, n=19). Cox Proportional hazards and logistic regression models were used to determine the case-mix adjusted association of oxygen requirements on day-30 with mortality and oxygen requirements at discharge.

Results: On multivariate analysis, use of ventilator (HR 5.1, p=.003) or ECMO (HR 19.6, p<.001) was a significant predictor of in-patient mortality. Need for non-invasive supplementation or ventilator on day-30 was associated with a respective 22-fold (p<.001) and 43-fold (p<.001) increased odds of oxygen use at discharge compared to those on room-air.

Conclusions: Pulmonary support on Day-30 is a strong predictor of length of stay, oxygen requirements at discharge and in-patient mortality and may be used as a simple prognostic indicator for family counseling, discharge planning, and identification of high-risk infants.

Keywords: Congenital anomaly; Extracorporeal membrane oxygenation; Mechanical ventilation; Risk assessment.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cohort Studies
  • Decision Support Techniques
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / therapy
  • Hernias, Diaphragmatic, Congenital*
  • Hospital Mortality*
  • Humans
  • Infant, Newborn
  • Length of Stay / statistics & numerical data*
  • Logistic Models
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Respiratory Therapy / methods
  • Respiratory Therapy / mortality*
  • Retrospective Studies
  • Risk Factors
  • Time Factors