Kazunori Masahata, Kouji Nagata, Keita Terui, Takuya Kondo, Ashley H. Ebanks, Matthew T. Hartling, Terry L. Buchmiller, Yasunori Sato, Hiroomi Okuyama, Noriaki Usui, Congenital Diaphragmatic Hernia Study Group
Osaka University Graduate School of Medicine. Kyushu University. Chiba University. McGovern Medical School at the University of Texas Health Science Center and Children’s Memorial Hermann Hospital. Keio University. Osaka Women’s and Children’s Hospital.
Japan and United States
Journal of Pediatric Surgery
J Pediatr Surg 2024;
DOI: 10.1016/j.jpedsurg.2024.01.016
Abstract
Background: We aimed to investigate the clinical characteristics and outcomes of patients with isolated left-sided congenital diaphragmatic hernia (CDH) who developed preoperative pneumothorax and determine its risk factors.
Methods: We performed an international cohort study of patients with CDH enrolled in the Congenital Diaphragmatic Hernia Study Group registry between January 2015 and December 2020. The main outcomes assessed included survival to hospital discharge and preoperative pneumothorax development. The cumulative incidence of pneumothorax was estimated by the Gray test. The Fine and Gray competing risk regression model was used to identify the risk factors for pneumothorax.
Results: Data for 2858 neonates with isolated left-sided CDH were extracted; 224 (7.8%) developed preoperative pneumothorax. Among patients with a large diaphragmatic defect, those with pneumothorax had a significantly lower rate of survival to discharge than did those without. The competing risks model demonstrated that a patent ductus arteriosus with a right-to-left shunt flow after birth (hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.21-2.63; p = 0.003) and large defects (HR: 1.65; 95% CI: 1.13-2.42; p = 0.01) were associated with an increased risk of preoperative pneumothorax. Significant differences were observed in the cumulative incidence of pneumothorax depending on defect size and shunt direction (p < 0.001).
Conclusions: Pneumothorax is a significant preoperative complication associated with increased mortality in neonates with CDH, particularly in cases with large defects. Large diaphragmatic defects and persistent pulmonary hypertension were found to be risk factors for preoperative pneumothorax development.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Symptoms and Findings Associated with Pulmonary Vascular Disease
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