Brindle M E, Brar M, Skarsgard E D
University of Calgary, Calgary, AB, Canada.
Pediatr Surg Int. 2011 Sep;27(9):969-74. doi: 10.1007/s00383-011-2925-1. Epub 2011 May 18.
Infants with congenital diaphragmatic hernia (CDH) have variable outcomes. There is a considerable potential benefit in being able to predict perinatally, which infants have severe hypoplasia and are thus more likely to die or survive with significant morbidity. We examine the relationship between a need for patch repair of CDH (PR) and outcome, using a national database.
Baseline characteristics of patients undergoing PR or non-patch repair (NPR) were compared. Multivariate analysis was performed to determine the association of PR with mortality and morbidity independent of other known predictors.
Baseline characteristics of PR and NPR infants were similar although those infants with PR had higher SNAP-II scores. PR was an independent predictor of mortality with an odds ratio of 17.1 (95%CI 2.0-149.2) and was independently associated with secondary outcome measures of morbidity, including the need for oxygen at discharge and the duration of ventilation.
Infants requiring PR have significantly higher mortality and suffer greater morbidity than those undergoing NPR. This association is independent of other known predictors of mortality. Identifying prenatal features associated with this high risk group would be of great clinical value.
先天性膈疝（CDH）患儿的预后各不相同。能够在围产期预测哪些婴儿有严重肺发育不全，从而更有可能死亡或存活但伴有严重并发症，具有相当大的潜在益处。我们使用一个全国性数据库研究了CDH补片修补术（PR）与预后之间的关系。
比较接受PR或非补片修补术（NPR）患者的基线特征。进行多变量分析以确定PR与死亡率和并发症的关联，独立于其他已知预测因素。
PR组和NPR组婴儿的基线特征相似，尽管PR组婴儿的SNAP-II评分较高。PR是死亡率的独立预测因素，比值比为17.1（95%CI 2.0-149.2），并且与并发症的次要结局指标独立相关，包括出院时需要吸氧和通气时间。
需要PR的婴儿比接受NPR的婴儿死亡率显著更高，且并发症更多。这种关联独立于其他已知的死亡率预测因素。识别与这个高危组相关的产前特征将具有很大的临床价值。
