Pagliara Camilla, Zambaiti Elisa, Brooks Giulia, Bonadies Luca, Tognon Costanza, Salvadori Sabrina, Sgrò Alberto, Leon Francesco Fascetti
Department of Pediatric Surgery, Universitary Hospital of Padova, 35128 Padova, Italy.
Department of Pediatric Surgery, Paediatric Hospital of Torino, 10126 Torino, Italy.
Children (Basel). 2023 Feb 7;10(2):315. doi: 10.3390/children10020315.
: Many prognostic factors for CDH patients are described and validated in the current literature: the size of diaphragmatic defects, need for patch repair, pulmonary hypertension and left ventricular dysfunction are recognized as the most influencing outcomes. The aim of this study is to analyze the influence of these parameters in the outcome of CDH patients in our department and identify any further prognostic factors. : An observational retrospective single-center study was conducted including all patients treated at our centre with posterolateral CDH between 01.01.1997 and 12.31.2019. The main outcomes evaluated were mortality and length of hospital stay. A univariate and multivariate analysis was performed. : We identified 140 patients with posterolateral CDH; 34.8% died before discharge. The overall median length of stay was 24 days. A univariate analysis confirmed that both outcomes are associated with the size of diaphragmatic defects, need for patch repair and presence of spleen-up ( < 0.05). A multivariate analysis identified that the need for patch repair and maximum dopamine dose used for cardiac dysfunction are independent parameters associated with the length of stay only ( < 0.001). : In our series, the duration of hospitalization is longer for newborns with CDH treated with higher doses of dopamine for left ventricular dysfunction or needing patch repair in large diaphragmatic defects.
目前的文献中描述并验证了许多先天性膈疝(CDH)患者的预后因素:膈缺损的大小、是否需要补片修补、肺动脉高压和左心室功能障碍被认为是对预后影响最大的因素。本研究的目的是分析这些参数对我院CDH患者预后的影响,并确定任何其他预后因素。
开展了一项观察性回顾性单中心研究,纳入了1997年1月1日至2019年12月31日期间在我院接受后外侧CDH治疗的所有患者。评估的主要结局为死亡率和住院时间。进行了单因素和多因素分析。
我们确定了140例后外侧CDH患者;34.8%在出院前死亡。总体中位住院时间为24天。单因素分析证实,这两个结局均与膈缺损的大小、是否需要补片修补以及脾脏上移有关(P<0.05)。多因素分析确定,是否需要补片修补以及用于治疗心功能不全的最大多巴胺剂量是仅与住院时间相关的独立参数(P<0.001)。
在我们的系列研究中,对于因左心室功能障碍而使用高剂量多巴胺治疗或因大的膈缺损需要补片修补的CDH新生儿,其住院时间更长。