Krysta M Sutyak 1, Kylie I Holden 2, Charles Green 3, Matthew T Harting 2, KuoJen Tsao 4, Kouji Nagata 5, Richard Keijzer 6, Marietta Jank 6, Tim Jancelewicz 7, Joseph T Church 8, Pamela A Lally 2, Kevin P Lally 4; For, The Congenital Diaphragmatic Hernia Study Group
McGovern Medical School and University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital. Kyushu University. University of Manitoba. University of Tennessee Health Science Center. University of Michigan Medical School.
United States, Japan and Canada
Journal of Pediatric Surgery
J Pediatr Surg 2026;
DOI: 10.1016/j.jpedsurg.2026.163005
Abstract
Introduction: The impact of hernia sac (HS+) on outcomes in congenital diaphragmatic hernia (CDH) when accounting for defect size is unknown. In a multicenter analysis, considering defect size, we aim to delineate the association of HS+ and morbidity and mortality.
Methods: A retrospective analysis of CDH Study Group (2007-2024) data was performed. Demographics, defect characteristics, morbidity, and mortality were abstracted. Multilevel regression and parallel Bayesian analysis were performed on 80% of the data, tested on 20% hold-out data, and reported in area under the curve (AUC).
Results: 7,828 operative CDH patients were included. HS+ in 20%; most common in A and B defects (24%, 25%), decreasing in C and D defects (17%, 7%); present in a greater proportion of right-sided defects (30% vs 18%, p<.001). On multilevel logistic regression, with random effects for center, controlling for birth weight, major cardiac abnormalities, chromosomal anomaly, utilization of ECLS, side of the defect, CDHSG A-D, HS+ was not associated with survival (OR 1.19, 95% CI 0.92-1.53). On Bayesian analysis the OR of HS+ on survival was 1.07 (95% credible interval 0.87-1.36). HS+ was not associated with pulmonary hypertension (OR 0.97, 95% CI 0.82-1.14) or cardiac dysfunction at birth. HS+ was associated with a reduction in ECLS utilization (OR 0.60, 95% CI 0.48-0.74), oxygen status at 30 days (OR 0.56, 95% CI 0.44-0.70), length of mechanical ventilation (IRR 0.84, 95% CI 0.79-0.89), and length of hospital stay (IRR 0.92, 95% CI 0.88-0.96).
Conclusion: HS+ is not associated with increased survival, with a neutral Bayesian probability of benefit. However, morbidity outcomes were improved in HS+ patients.
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: No