Meng Chuyi,Feng Zhong,Wang Ying,et al.Analysis of clinical outcomes for infants with congenital diaphragmatic hernia under a multidisciplinary diagnostic and treatment approach[J].Journal of Clinical Pediatric Surgery,,22():706-712.[doi:10.3760/cma.j.cn101785-202304028-002]
Analysis of clinical outcomes for infants with congenital diaphragmatic hernia under a multidisciplinary diagnostic and treatment approach
- Keywords:
- Hernias; Diaphragmatic; Congenital; Multidisciplinary Treatment; Extracorporeal Membrane Oxygenation; Treatment Outcome; Comparative Study
- Abstract:
- Objective To explore the clinical outcomes and prognostic factors associated with infants of congenital diaphragmatic hernia (CDH) under multidisciplinary treatments.Methods The relevant clinical data were collected from 103 cases of prenatally diagnosed CDH treated from January 2016 to August 2022.Based upon whether or not fulfilling the criteria for using extracorporeal membrane oxygenation (ECMO) within 24h post-birth, they were assigned into two groups of ECMO-indicated (n=39) and non-ECMO-indicated (n=64).Clinical outcomes, echocardiographic findings and independent risk factors were examined for mortality in ECMO-indicated group.Results The overall discharge mortality rate was 29.1%(95%CI:20.6%-38.9%).And mortality rate in ECMO-indicated group was higher than that in non-indicated group[53.9%(95%CI:37.2%-69.9%) vs.14.1%(95%CI:6.6%-25%)].The median duration of invasive ventilator use in survivors was 336.5(160.5, 578.5) hours with a median hospital stay of 37.5(22.8, 51.3) days.In contrast, 177.0(121.0-311.0) hours and 25(19, 34) days in non-indicated group respectively.Proportion of right-sided diaphragmatic hernia, occurrence of hepatic hernia and extent of diaphragmatic defect were higher in ECMO-indicated group (P<0.05).Early pulmonary hypertension of ECMO-indicated group was more severe(P<0.01) with higher incidences of right heart enlargement (69.7% vs.27.3%, P<0.01) and left ventricular dysfunction (18.2% vs.0, P<0.01).Multivariate regression analysis revealed that for ECMO-indicated group, a diagnostic gestational age of 25 weeks, PaCO2 and oxygenation index (OI) are independent morality risk factors (P<0.05).Conclusion Despite non-using ECMO, our center achieved a mortality rate comparable to that of international high-volume treatment centers for high-risk CDH patients through strengthening an integrated management model before, during and after childbirth.ECMO-indicated CDH patients have more severe pulmonary arterial hypertension and a higher incidence of heart dysfunction.In addition, gestational age at diagnosis <25 weeks, PCO2 and OI were independent risk factors for mortality in this cohort of patients.
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Memo
收稿日期:2023-04-11。
基金项目:2022年度慢性病防治与健康教育科研项目（BJMB0012022028001）；北京市自然科学基金资助项目（7224321）；北京市儿科学科协同发展中心儿科重点专项（XTZD20180305）
通讯作者:马立霜,Email:malishuang2006@126.com