Link: https://www.ncbi.nlm.nih.gov/pubmed/30130827

Eur J Pediatr Surg. 2018 Aug 21. doi: 10.1055/s-0038-1668563. [Epub ahead of print]
First Population-Based Report of Infants with Congenital Diaphragmatic Hernia: 30-Day Outcomes from the American College of Surgeons National Quality Improvement Program.
Zani-Ruttenstock E1,2, Zani A1,2, Eaton S3, Fecteau A1,2.
Author information
Abstract
AIM:
 The American College of Surgeons has developed a registry, the National Quality Improvement Program Pediatric (NSQIP-P), that provides participating centers with high-quality surgical outcome data for children. Herein, we aimed to analyze for the first time the short-term outcomes of live-born infants with congenital diaphragmatic hernia (CDH) registered on this large North American database.

METHODS:
 During 2015 to 2016, up to 101 participating centers uploaded 95 perioperative data points on the NSQIP-P database for patients that underwent surgical repair of CDH. The demographics, peri-, and post-operative data (up to 30 days following surgical repair) of infants with CDH were reviewed. Binary logistic regression was performed to test associations between risk factors and mortality.

MAIN RESULTS:
 There were 432 (61% male) infants, who underwent CDH surgical repair during the study period. The prematurity rate (gestational age < 37 weeks) was 17%. The majority of infants (82%) had cardiac risk factors identified (72% were reported as major/severe). Extracorporeal membrane oxygenation (ECMO) was employed in 13% of patients prior to surgery. The majority of infants (83%) were ventilated preoperatively, and 34% received inotropes. Median age at surgery was 5 (0-74) days. CDH repair was attempted via thoracoscopy in 18% (n = 79) infants, but with a high rate of conversion to open surgery (n = 32, 41%). The postoperative 30-day mortality rate was 9%. At binary logistic regression, major cardiac risk factors (odds ratio [OR], 1.7 [0.9-3.2], p = 0.095), Appearance, Pulse, Grimace, Activity, and Respiration at 1 minute (OR, 0.7 per unit [0.5-0.8], p < 0.005), and birth weight (OR, 0.5 per kg [0.2-1.0], p < 0.05) were retained in the final model as significantly associated with mortality.

CONCLUSION:
 This is the first report on CDH outcomes from the NSQIP-P database. Utilization of ECMO was low compared with single-center studies from North America. The early postoperative mortality rate of babies with CDH considered suitable for surgery remains high.

Georg Thieme Verlag KG Stuttgart · New York.

PMID: 30130827 DOI: 10.1055/s-0038-1668563