دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study.
المؤلفون: Lum LCS; Department of Pediatrics, University Malaya Medical Center, 59100, Lembah Pantai, Kuala Lumpur, Malaysia. lumcs@ummc.edu.my., Ramanujam TM; Division of Pediatric Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia., Yik YI; Division of Pediatric Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia., Lee ML; Department of Pediatrics, Hospital Tengku Ampuan Afzan, Pahang, Malaysia., Chuah SL; Department of Pediatrics, University Malaya Medical Center, 59100, Lembah Pantai, Kuala Lumpur, Malaysia., Breen E; Clinical Investigation Center, University of Malaya Medical Center, 5th Floor East Tower, Kuala Lumpur, Malaysia., Zainal-Abidin AS; Department of Pediatrics, Universiti Teknologi MARA, Selangor, Malaysia., Singaravel S; Division of Pediatric Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia., Thambidorai CR; Division of Pediatric Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia., de Bruyne JA; Department of Pediatrics, University Malaya Medical Center, 59100, Lembah Pantai, Kuala Lumpur, Malaysia., Nathan AM; Department of Pediatrics, University Malaya Medical Center, 59100, Lembah Pantai, Kuala Lumpur, Malaysia., Thavagnanam S; Queen Mary University of London, Barts Health NHS Trust, Royal London Children's Hospital, London, UK., Eg KP; Department of Pediatrics, University Malaya Medical Center, 59100, Lembah Pantai, Kuala Lumpur, Malaysia., Chan L; Department of Anesthesia, University Malaya Medical Center, Kuala Lumpur, Malaysia., Abdel-Latif ME; Department of Neonatology, Centenary Hospital for Women and Children, The Canberra Hospital, Canberra, ACT, Australia.; Department of Public Health, La Trobe University, Bundoora, Melbourne, VIC, Australia., Gan CS; Department of Pediatrics, University Malaya Medical Center, 59100, Lembah Pantai, Kuala Lumpur, Malaysia.
المصدر: BMC pediatrics [BMC Pediatr] 2022 Jul 07; Vol. 22 (1), pp. 396. Date of Electronic Publication: 2022 Jul 07.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967804 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2431 (Electronic) Linking ISSN: 14712431 NLM ISO Abbreviation: BMC Pediatr Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BioMed Central, [2001-
مواضيع طبية MeSH: Hernias, Diaphragmatic, Congenital*/diagnosis , High-Frequency Ventilation*, Child ; Female ; Humans ; Infant, Newborn ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Survival Rate
مستخلص: 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.
(© 2022. The Author(s).)
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فهرسة مساهمة: Keywords: Congenital; Diaphragmatic; Hernias; Infant; Intensive care units; Newborn; Pediatric; Prenatal diagnosis; Risk factors; Survival
تواريخ الأحداث: Date Created: 20220707 Date Completed: 20220711 Latest Revision: 20220801
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC9264560
DOI: 10.1186/s12887-022-03453-5
PMID: 35799173
قاعدة البيانات: MEDLINE
الوصف
تدمد:1471-2431
DOI:10.1186/s12887-022-03453-5