HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Improved mortality rate for congenital diaphragmatic hernia in the modern era of management: 15 year experience in a single institution.

AbstractBACKGROUND/PURPOSE:
Mortality rates with congenital diaphragmatic hernia (CDH) have remained at approximately 30% for the last 2 decades. Therapies targeting pulmonary hypertension (PHTN) have not been systematically studied in this population, but are increasingly used. We hypothesized that incremental changes in treatments for PHTN have improved mortality for CDH infants.
METHODS:
Prospective data from 1998 to 2013 on all liveborn CDH patients treated at our institution were retrospectively analyzed. Based on management of PHTN, 4 eras were identified for comparison. Logistic and linear regression were used to compare characteristics. The primary outcome of death prior to discharge was analyzed by multivariable Cox regression modeling.
RESULTS:
The study included 192 infants who met inclusion criteria. Length of stay increased, whereas rates of primary repair decreased, suggesting a sicker cohort in the most recent eras. Analysis of mortality across 4 eras showed no difference. By post-hoc analysis, ECMO availability was associated with mortality reduction for eras 3-4 versus 1-2 (HR=0.27, p<0.001).
CONCLUSIONS:
Improved survival at our institution may be related to recent introduction of ECMO and more aggressive approaches to pulmonary hypertension. Further systematic studies of these PHTN therapies in this specific population are warranted.
AuthorsJennifer M Zalla, Gregory J Stoddard, Bradley A Yoder
JournalJournal of pediatric surgery (J Pediatr Surg) Vol. 50 Issue 4 Pg. 524-7 (Apr 2015) ISSN: 1531-5037 [Electronic] United States
PMID25840055 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
CopyrightCopyright © 2015 Elsevier Inc. All rights reserved.
Topics
  • Disease Management
  • Extracorporeal Membrane Oxygenation (methods)
  • Female
  • Hernias, Diaphragmatic, Congenital (mortality, therapy)
  • Humans
  • Infant, Newborn
  • Male
  • Prospective Studies
  • Retrospective Studies
  • Survival Rate (trends)
  • United States (epidemiology)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: