Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Afr J Paediatr Surg. 2023 Apr-Jun;20(2):85-88. doi: 10.4103/ajps.ajps_165_21.
Despite all the advances, the mortality rate of congenital diaphragmatic hernia (CDH) ranges from 30% to 60% for isolated CDH and as high as 89% when they are associated with additional structural or chromosomal anomalies. Hence, a study was conducted to evaluate the factors contributing to the mortality of neonates treated for CDH or the eventration of diaphragm.
A retrospective study was conducted in the department of paediatric surgery at a tertiary centre. The neonates admitted with a diagnosis of CDH or eventration requiring surgery, between March 2013 and March 2021, were included in the study.
A total of 123 neonates were included in the study. The variables, earlier median age at presentation (1 [1-23] vs. 3 [1-28]; P < 0.001; Mann-Whitney U-test), preterm birth (10/79 vs. 0/44; P = 0.01; Fischer's exact test), inborn (68/79 vs. 27/44; P = 0.002; Chi-square test), weight ≤2 kg (18/79 vs. 1/44; P = 0.003; Chi-square test), central cyanosis at presentation (21/79 vs. 1/44; P < 0.001; Chi-square test), antenatal detection (47/79 vs. 14/44; P = 0.003; Chi-square test) and earlier mean age at surgery (3.66 ± 1.47 vs. 7.66 ± 6.88; P < 0.001; Independent sample t-test) were associated with increased mortality. On multinominal logistic regression analysis, the factors preterm (odd's Ratio [OR] =4.735; P = 0.03), weight ≤2 kg (OR = 5.081; P = 0.02), central cyanosis at presentation (OR = 6.969; P = 0.008) and antenatal detection (OR = 7.471; P = 0.006) were found to be independently associated with increased mortality in CDH/eventration.
The factors: prematurity, weight <2 kg, cyanosis at presentation and antenatal diagnosis were independently associated with increased mortality in neonates with CDH/eventration requiring surgery.
尽管取得了所有进展，先天性膈疝（CDH）的死亡率仍在孤立性 CDH 的 30%至 60%之间，而当与其他结构性或染色体异常相关时，死亡率高达 89%。因此，进行了一项研究，以评估导致接受 CDH 或膈肌膨出治疗的新生儿死亡的因素。
在一家三级中心的小儿外科系进行了一项回顾性研究。纳入 2013 年 3 月至 2021 年 3 月期间因 CDH 或膈肌膨出需要手术而入院的新生儿。
共有 123 名新生儿纳入研究。在较早的中位年龄（1 [1-23] vs. 3 [1-28]；P < 0.001；Mann-Whitney U 检验）、早产（10/79 与 0/44；P = 0.01；Fisher 确切检验）、宫内（68/79 与 27/44；P = 0.002；卡方检验）、体重≤2 kg（18/79 与 1/44；P = 0.003；卡方检验）、入院时中央发绀（21/79 与 1/44；P < 0.001；卡方检验）、产前检测（47/79 与 14/44；P = 0.003；卡方检验）和较早的手术中位年龄（3.66 ± 1.47 vs. 7.66 ± 6.88；P < 0.001；独立样本 t 检验）方面，死亡率增加。在多项二项逻辑回归分析中，早产（优势比 [OR] =4.735；P = 0.03）、体重≤2 kg（OR = 5.081；P = 0.02）、入院时中央发绀（OR = 6.969；P = 0.008）和产前诊断（OR = 7.471；P = 0.006）是 CDH/膈肌膨出手术新生儿死亡的独立危险因素。
早产、体重<2 kg、入院时发绀和产前诊断是 CDH/膈肌膨出手术新生儿死亡的独立危险因素。
