Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia: A Multicenter Analysis

Alexey Abramov, Weijia Fan, Rebecca Hernan, Ariela L. Zenilman, Julia Wynn, Gudrun Aspelund, Julie Khlevner, Usha Krishnan, Foong Yen Lim, George B. Mychaliska, Brad W. Warner, Robert Cusick, Timothy Crombleholme, Dai Chung, Melissa E. Danko, Amy J. Wagner, Kenneth Azarow, David Schindel, Douglas Potoka, Sam SofferJason Fisher, David McCulley, Christiana Farkouh-Karoleski, Wendy K. Chung, Vincent Duron

Research output: Contribution to journalArticle

Abstract

Background: Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500–3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH). Methods: We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH. Results: A total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p = 0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p = 0.022) and a higher frequency of need for oxygen at discharge (p = 0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence. Conclusion: In this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair. Type of study: Prognosis study Level of evidence: Level II

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Oxygen
Lung
Mortality
Live Birth
Patient Rights
Hernia
Pulmonary Hypertension
Multivariate Analysis
Head
Newborn Infant
Databases
Recurrence
Muscles
Congenital Diaphragmatic Hernias

Keywords

  • Congenital diaphragmatic hernia
  • Critical care
  • ECMO
  • Thoracic

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Abramov, A., Fan, W., Hernan, R., Zenilman, A. L., Wynn, J., Aspelund, G., ... Duron, V. (Accepted/In press). Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia: A Multicenter Analysis. Journal of pediatric surgery. https://doi.org/10.1016/j.jpedsurg.2019.09.046

Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia : A Multicenter Analysis. / Abramov, Alexey; Fan, Weijia; Hernan, Rebecca; Zenilman, Ariela L.; Wynn, Julia; Aspelund, Gudrun; Khlevner, Julie; Krishnan, Usha; Lim, Foong Yen; Mychaliska, George B.; Warner, Brad W.; Cusick, Robert; Crombleholme, Timothy; Chung, Dai; Danko, Melissa E.; Wagner, Amy J.; Azarow, Kenneth; Schindel, David; Potoka, Douglas; Soffer, Sam; Fisher, Jason; McCulley, David; Farkouh-Karoleski, Christiana; Chung, Wendy K.; Duron, Vincent.

In: Journal of pediatric surgery, 01.01.2019.

Research output: Contribution to journalArticle

Abramov, A, Fan, W, Hernan, R, Zenilman, AL, Wynn, J, Aspelund, G, Khlevner, J, Krishnan, U, Lim, FY, Mychaliska, GB, Warner, BW, Cusick, R, Crombleholme, T, Chung, D, Danko, ME, Wagner, AJ, Azarow, K, Schindel, D, Potoka, D, Soffer, S, Fisher, J, McCulley, D, Farkouh-Karoleski, C, Chung, WK & Duron, V 2019, 'Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia: A Multicenter Analysis', Journal of pediatric surgery. https://doi.org/10.1016/j.jpedsurg.2019.09.046
Abramov, Alexey ; Fan, Weijia ; Hernan, Rebecca ; Zenilman, Ariela L. ; Wynn, Julia ; Aspelund, Gudrun ; Khlevner, Julie ; Krishnan, Usha ; Lim, Foong Yen ; Mychaliska, George B. ; Warner, Brad W. ; Cusick, Robert ; Crombleholme, Timothy ; Chung, Dai ; Danko, Melissa E. ; Wagner, Amy J. ; Azarow, Kenneth ; Schindel, David ; Potoka, Douglas ; Soffer, Sam ; Fisher, Jason ; McCulley, David ; Farkouh-Karoleski, Christiana ; Chung, Wendy K. ; Duron, Vincent. / Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia : A Multicenter Analysis. In: Journal of pediatric surgery. 2019.
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T1 - Comparative Outcomes of Right Versus Left Congenital Diaphragmatic Hernia

T2 - A Multicenter Analysis

AU - Abramov, Alexey

AU - Fan, Weijia

AU - Hernan, Rebecca

AU - Zenilman, Ariela L.

AU - Wynn, Julia

AU - Aspelund, Gudrun

AU - Khlevner, Julie

AU - Krishnan, Usha

AU - Lim, Foong Yen

AU - Mychaliska, George B.

AU - Warner, Brad W.

AU - Cusick, Robert

AU - Crombleholme, Timothy

AU - Chung, Dai

AU - Danko, Melissa E.

AU - Wagner, Amy J.

AU - Azarow, Kenneth

AU - Schindel, David

AU - Potoka, Douglas

AU - Soffer, Sam

AU - Fisher, Jason

AU - McCulley, David

AU - Farkouh-Karoleski, Christiana

AU - Chung, Wendy K.

AU - Duron, Vincent

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500–3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH). Methods: We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH. Results: A total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p = 0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p = 0.022) and a higher frequency of need for oxygen at discharge (p = 0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence. Conclusion: In this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair. Type of study: Prognosis study Level of evidence: Level II

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KW - Congenital diaphragmatic hernia

KW - Critical care

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KW - Thoracic

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