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Prognostic factors of death in children during the first year of life due to congenital diaphragmatic hernia: Analysis of a hospital cohort from 2005 to 2015

Introduction: Congenital diaphragmatic hernia (CDH) is associated with a failure in the fusion of the caudal pleuroperitoneal membranes that form the diaphragm, resulting in a defect of continuity, with potential thoracic migration of the abdominal structures under formation, resulting in compression of the lungs.1---3. Therefore, the aim of this study was to describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit.

Method: In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi-squared test and Student’s t-test.

Results: The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy-nine (61%) patients died, 50 survived, and 33 had other associated malforma-tions. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p = 0.001), gestational age of the earliest diagnosis (p = 0.004), asso-ciated congenital abnormalities (OR: 3.013, p = 0.022), pO2 of the first gasometry (p = 0.000), pCO2 of the first gasometry (p = 0.000), presence of pulmonary hypoplasia (OR: 3.074, p = 0.000), use of preoperative vasoactive drugs (OR: 2.881, p = 0.000), and use of nitric oxide (OR: 1.739, p = 0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p = 0.001).

Conclusion: The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005---2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.

Author(s): Roberta Ivanira Silva do Carmo, Fernando Maia Peixoto-Filho, Arnaldo Bueno, Marlon Fonseca and Saint Clair dos Santos Gomes Junior

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