Link: http://www.ncbi.nlm.nih.gov/pubmed/25783313

J Pediatr Surg. 2014 Dec 17. pii: S0022-3468(14)00842-2. doi: 10.1016/j.jpedsurg.2014.12.007. [Epub ahead of print]

Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia.

Cauley RP1, Potanos K1, Fullington N1, Bairdain S1, Sheils CA2, Finkelstein JA2, Graham DA3, Wilson JM4.
Author information
1Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
2Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
3Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
4Department of Surgery, Boston Children's Hospital, Boston, MA, USA. Electronic address: jay.wilson@childrens.harvard.edu.

Abstract
PURPOSE:
Pulmonary support (PS) on day-of-life-30 (DOL-30) has been shown to be the strongest predictor of subsequent morbidity and in-patient mortality in congenital diaphragmatic hernia (CDH). We hypothesized that PS on DOL-30 can also predict long-term outcomes in CDH survivors.

METHODS:
We analyzed records of 201 CDH survivors followed by a single multidisciplinary clinic (1995-2010). Follow-up was 83 and 70% at 1 and 5years respectively. PS was defined as: (1) invasive support (n=44), (2) noninvasive support (n=54), or (3) room air (n=103). Logistic regression was used to estimate the adjusted association of PS on DOL-30 with outcomes at 1 and 5-years.

RESULTS:
Use of PS on DOL-30 was significantly associated with pulmonary and developmental morbidities at 1 and 5-years. Even after adjusting for defect-size and presence of ventilation/perfusion mismatch, greater PS on DOL-30 was associated with a significantly increased odds of requiring supplemental oxygen and developmental referral at 1-year, and asthma and developmental referral at 5-years.

CONCLUSION:
CDH survivors continue to have significant long-term pulmonary and developmental morbidities. PS on DOL-30 is a strong independent predictor of morbidity at 1 and 5-years and may be used as a simple prognostic tool to identify high-risk infants.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:
Congenital anomaly; Extracorporeal membrane oxygenation; Mechanical ventilation; Risk assessment
PMID: 25783313 [PubMed - as supplied by publisher]