Duong Anh Dang, Thuan Van Nguyen, Dung Thi Thu Nguyen, Dung Thi Pham, Phuong Thi Ha Nguyen, Thuong Duc Nguyen, Tuan Anh Pham, Dung Thi Thuy Le, Mung Thi Ngo, My Ha Nguyen, Hien Hai Dao, Son Hong Pham, Mai Thi Thanh Nguyen, Ha Thi Thu Tran, Son Ngoc Do, Ngoc Huy Nguyen, Chinh Quoc Luong
Vietnam National Children’s Hospital. Vietnam National University. Hanoi Medical University. Thai Binh University of Medicine and Pharmacy. Phu Tho Provincial General Hospital. Bach Mai Hospital. Phu Tho Department of Health.
Vietnam
BioMedical Central Pediatrics
BMC Pediatr 2025; 25:
DOI: 10.1186/s12887-025-06108-3
Abstract
Background: Congenital diaphragmatic hernia (CDH) has a high mortality rate, particularly in low- and middle-income countries. This study aimed to investigate mortality rates and associated factors in CDH neonates in Vietnam.
Methods: This retrospective observational study included CDH neonates admitted to a central children’s hospital in Vietnam between November 2021 and September 2023. We collected data on neonates’ characteristics, management, complications, and outcomes, comparing these data between survivors and non-survivors. We also employed logistic regression analysis to identify factors associated with hospital mortality.
Results: Of 74 neonates with CDH, 64.9% (48/74) were male. The hospital mortality rate was 50.0% (37/74). The median gestational age at birth was 38 weeks (interquartile range [IQR]: 38-39), and the median age at admission was 5.2 h (IQR: 3.0-15.8). All neonates were referred from various prior hospitals, with 83.8% (62/74) requiring immediate postnatal intubation. The neonates presented in critical condition, as reflected by a median pre- and post-ductal SpO2 difference of 2.5% (IQR: 1.0-10.0), a mean pulmonary artery systolic pressure (PASP) of 51.7 mmHg (standard deviation: 18.3) on admission, and a median Oxygenation Index at 6 h of life of 13.3 (IQR: 6.8-28.2). The median peak Vasoactive Inotropic Score (VIS) during surgical intensive care unit stay was 35.0 (IQR: 15.0-80.0). High-frequency oscillatory ventilation was used as the initial ventilatory mode in 52.7% (39/74) of cases. Supportive therapies included vasopressors (84.9%; 62/73), inotropic agents (29.6%; 21/71), inhaled nitric oxide (13.5%; 10/74), Ilomedin (29.7%; 19/64), and extracorporeal membrane oxygenation (6.8%; 5/74). Surgical repair was performed in 70.3% (52/74) of neonates. Multivariable logistic regression analysis identified higher peak VIS (adjusted odds ratio [AOR]: 1.061; 95% confidence interval [CI]: 1.011-1.113; p = 0.017) and elevated admission PASP (AOR: 1.140; 95% CI: 1.041-1.247; p = 0.005) as independent predictors of hospital mortality.
Conclusions: In this selected cohort of CDH neonates admitted to a central children’s hospital in Vietnam, a high hospital mortality rate was observed. The findings suggest that limited access to neonatal intensive care and surgical repair may have influenced outcomes, warranting further evaluation in similar resource-limited settings to improve care strategies.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes