Addressing the causes of late mortality in infants with congenital diaphragmatic hernia

作者：Burgos Carmen Mesas^*; Modee Agnes; Frenckner Bjorn

来源：Journal of Pediatric Surgery, 2017, 52(4): 526-529.

DOI：10.1016/j.jpedsurg.2016.08.028

• Congenital diaphragmatic hernia (CDH)
• Mortality
• Late mortality
• Outcome
• Follow-up

Introduction: Despite improvements of neonatal intensive care, mortality among patients born with congenital diaphragmatic hernia (CDH), remains high, and there is a significant late mortality in this cohort.
Objective: The aimof this study was to evaluate the causes of death among 251 consecutive CDH patients treated at our institution during the last 26 years period.
Methods: Retrospective review of all causes of death between 1990 and 2015 of the CDH cohort prospectively collected in a database.
Results: Of the 251 CDH patients treated in our department since 1990, 49 were not alive by the end of 2015. Thirty-six patients (14%) died before discharge, and 13 (5%) after the first care event. The mean age at death was 262 days (+/- 653 days, median 34 days). Eighty six % (42 cases) of the fatalities occurred during the first year of life, more than half of the patients died before 1 month of age and only 13% after the age of 1 year (7 patients) (late mortality). The causes of early mortality (before 1 year of age) were mainly cardio-respiratory, whereas GI complications occurred in the late mortality group.
Conclusion: The most common cause of death among CDH patients is respiratory insufficiency and associated pulmonary hypertension, andmost of the fatalities occur before 1 year of age. Among older patients, gastrointestinal morbidity as cause of death is highly represented. Level of evidence: II.

• 出版日期2017-4