先天性膈疝新生儿死亡率的预测因素：来自印度未选择性出生队列的经验。

Predictors of Mortality among Neonates with Congenital Diaphragmatic Hernia: Experience from an Inborn Unselected Cohort in India.

机构信息

Division of Neonatology, Newborn Health Knowledge Centre (NHKC), WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Anu Thukral, Assistant Professor, Department of Paediatrics, WHO Collaborating Centre for Education and Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029.

出版信息

Indian Pediatr. 2019 Dec 15;56(12):1037-1040.

PMID:31884435

Abstract

OBJECTIVE

To evaluate the clinical profile and predictors of mortality in neonates with congenital diaphragmatic hernia (CDH).

METHODS

Demographic and clinical parameters of neonates with congenital diaphragmatic heria (n=37) between January 2014 and October, 2017 were reviewed, and compared among those who survived or expired in hospital.

RESULTS

Median (range) gestation and birthweight were 38 (37-39) weeks and 2496 (2044-2889) g, respectively. Persistent pulmonary hypertension (PPHN) was documented in 19 (51%) neonates and 10 (27%) had associated malformations. Surgery could be performed in 18 (49%), overall mortality was 60%. On univariate analysis, low Apgar scores, presence of malformations, PPHN, need for higher initial peak inspiratory pressure/high frequency ventilation, and requirement of a patch for closure were associated with increased mortality. On multivariate analysis, PPHN remained the only significant risk factor [adjusted RR 3.74 (95% CI 1.45-9.68)].

CONCLUSIONS

The survival of infants with CDH is low, and PPHN is an important predictor of mortality.

摘要

目的

评估先天性膈疝（CDH）新生儿的临床特征和死亡预测因素。

方法

回顾 2014 年 1 月至 2017 年 10 月期间患有先天性膈疝的新生儿（n=37）的人口统计学和临床参数，并比较在医院存活或死亡的患者之间的差异。

结果

中位数（范围）胎龄和出生体重分别为 38（37-39）周和 2496（2044-2889）g。19 例（51%）新生儿存在持续性肺动脉高压（PPHN），10 例（27%）存在相关畸形。18 例（49%）可进行手术，总死亡率为 60%。单因素分析显示，低 Apgar 评分、存在畸形、PPHN、需要更高的初始峰吸气压/高频通气以及需要补丁修补与死亡率增加相关。多因素分析显示，PPHN 仍然是唯一显著的死亡风险因素[调整后的 RR 3.74（95% CI 1.45-9.68）]。