Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA.
J Pediatr. 2013 Jul;163(1):114-9.e1. doi: 10.1016/j.jpeds.2012.12.036. Epub 2013 Jan 30.
To identify clinical factors associated with pulmonary hypertension (PH) and mortality in patients with congenital diaphragmatic hernia (CDH).
A prospective cohort of neonates with a diaphragm defect identified at 1 of 7 collaborating medical centers was studied. Echocardiograms were performed at 1 month and 3 months of age and analyzed at a central core by 2 cardiologists independently. Degree of PH and survival were tested for association with clinical variables using Fischer exact test, χ(2), and regression analysis.
Two hundred twenty patients met inclusion criteria. Worse PH measured at 1 month of life was associated with higher mortality. Other factors associated with mortality were need for extracorporeal membrane oxygenation, patients inborn at the treating center, and patients with a prenatal diagnosis of CDH. Interestingly, patients with right sided CDH did not have worse outcomes.
Severity of PH is associated with mortality in CDH. Other factors associated with mortality were birth weight, gestational age at birth, inborn status, and need for extracorporeal membrane oxygenation.
确定与先天性膈疝（CDH）患者肺动脉高压（PH）和死亡率相关的临床因素。
对在 7 个合作医疗中心中的 1 个中心发现膈缺损的新生儿进行前瞻性队列研究。在 1 个月和 3 个月大时进行超声心动图检查，并由 2 位心脏病专家在中心核心处进行独立分析。使用 Fisher 精确检验、χ(2)检验和回归分析，检验 PH 严重程度和存活率与临床变量的相关性。
220 名患者符合纳入标准。1 个月大时测量的 PH 严重程度与死亡率较高相关。其他与死亡率相关的因素包括需要体外膜氧合、在治疗中心出生的患者以及产前诊断为 CDH 的患者。有趣的是，右侧 CDH 患者的预后并不差。
PH 的严重程度与 CDH 的死亡率相关。其他与死亡率相关的因素包括出生体重、出生时的胎龄、出生地和需要体外膜氧合。
