Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery |
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Authors: | Rozmiarek Andrew J Qureshi Faisal G Cassidy Laura Ford Henri R Hackam David J |
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Institution: | a Division of Pediatric Surgery, Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, USA b Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA |
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Abstract: | PurposeControversy persists regarding the factors influencing survival in patients with congenital diaphragmatic hernia (CDH), in particular, the role of timing of surgery. The authors therefore sought to determine such factors and to assess the relative role of timing of surgery on outcome.MethodsAll CDH newborns 1991 through 2002 (n = 111) were divided into those undergoing repair before (“early” n = 35), or after (“late” n = 76) 48 hours. A multivariate analysis was performed to determine the relative impact of various factors on survival rate.ResultsOverall survival rate was 64%. There was no effect on survival of heart rate, temperature, systolic blood pressure, age, extracorporeal membrane oxygenation use, mesh use, infections, or intracranial hemorrhage, and there was no difference between early (68%) or late (62%) repair (P = .2). Initial pco2 greater than 50, po2 less than 40, cardiac defects, or renal failure significantly decreased survival rate.ConclusionsSignificant factors influencing survival rate in patients with CDH include cardiac defects, renal failure, and the initial blood gases and not the timing of surgery. CDH repair should be based on the optimization of clinical parameters as opposed to a specific time period to improve outcome. |
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Keywords: | Respiratory failure extracorporeal membrane oxygenation lung neonate |
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