Prognostic factors of death in children during the first year of life due to congenital diaphragmatic hernia: analysis of a hospital cohort from 2005 to 2015

Abstract

Objective

To describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit.

Method

In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi‐squared test and Student's t‐test.

Results

The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy‐nine (61%) patients died, 50 survived, and 33 had other associated malformations. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p = 0.001), gestational age of the earliest diagnosis (p = 0.004), associated congenital abnormalities (OR: 3.013, p = 0.022), pO₂ of the first gasometry (p = 0.000), pCO₂ of the first gasometry (p = 0.000), presence of pulmonary hypoplasia (OR: 3.074, p = 0.000), use of preoperative vasoactive drugs (OR: 2.881, p = 0.000), and use of nitric oxide (OR: 1.739, p = 0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p = 0.001).

Conclusion

The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005–2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.