Link: https://www.ncbi.nlm.nih.gov/pubmed/30824242

J Pediatr Surg. 2019 Jan 31. pii: S0022-3468(19)30053-3. doi: 10.1016/j.jpedsurg.2019.01.016. [Epub ahead of print]
The presence of a hernia sac in isolated congenital diaphragmatic hernia is associated with less disease severity: A retrospective cohort study.
Levesque M1, Derraugh G1, Schantz D2, Morris MI1, Shawyer A1, Lum Min SA1, Keijzer R3.
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Abstract
INTRODUCTION:
We aimed to determine if the presence of a hernia sac in neonates with isolated congenital diaphragmatic hernia (CDH) was associated with better clinical outcomes.

METHODS:
We performed a retrospective cohort study of infants with isolated CDH from 1991 to 2015. Primary outcome measures were oxygen-dependence and mortality at 28 days. Secondary measures were: inhaled nitric oxide use, vasoactive medication use, ventilator support, and recurrence rates.

RESULTS:
Seventy-one patients met the inclusion criteria: 14 patients (19.7%) had a hernia sac, and 57 patients (80.3%) did not. Mortality did not differ between the 2 groups [0 of 14 versus 3 of 57 (5.3%) (p = 1.000)]. Hernia sac patients had similar oxygen-dependence after 28 days [1 of 14 (7.1%) versus 14 of 57 (24.6%) (p = 0.273)]. Hernia sac children required less iNO (0.64 ± 2.41 vs. 6.35 ± 12.2 days, p = 0.002), vasoactive medications (2.79 ± 3.07 vs. 5.36 ± 5.52, p = 0.027), and time on ventilation (7.62 ± 6.12 vs. 15.9 ± 19.2, p = 0.010). Hernia sac children had similar recurrence rates within 2 years [0 of 14 versus 7 of 57 (12.3%) (p = 0.331)].

CONCLUSION:
The presence of a hernia sac was not associated with lower rates of oxygen dependency or death at 28 days but was associated with decreased inhaled nitric oxide, vasoactive medication, and ventilator use.

LEVEL OF EVIDENCE:
III.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:
Congenital diaphragmatic hernia; Hernia sac; Outcomes

PMID: 30824242 DOI: 10.1016/j.jpedsurg.2019.01.016