Advanced

Congenital diaphragmatic hernia in Scandinavia from 1995 to 1998: Predictors of mortality.

Skari, Hans; Bjornland, Kristin; Frenckner, Bjorn; Friberg, Lars; Heikkinen, Marja; Hurme, Timo; Loe, Borger; Mollerlokken, Gunnhild; Nielsen, Ole and Qvist, Niels, et al. (2002) In Journal of Pediatric Surgery 37(9). p.1269-1275
Abstract
BACKGROUND/PURPOSE: There is a lack of large contemporary studies on the management of congenital diaphragmatic hernia (CDH), and the prediction of mortality remains difficult. The aim of this study was to investigate the influence of perinatal factors on mortality rate in a contemporary multicenter study. METHODS: The authors conducted a retrospective multicenter cohort study. Twelve of 13 Scandinavian pediatric surgical centers participated in the study. During a 4-year period (1995 through 1998) 195 children with CDH were included. The main endpoints were hospital mortality rate and total mortality rate (before 2001). Bivariate and multivariate survival analyses were performed using Kaplan-Meier plots, Log-rank test, and Cox regression.... (More)
BACKGROUND/PURPOSE: There is a lack of large contemporary studies on the management of congenital diaphragmatic hernia (CDH), and the prediction of mortality remains difficult. The aim of this study was to investigate the influence of perinatal factors on mortality rate in a contemporary multicenter study. METHODS: The authors conducted a retrospective multicenter cohort study. Twelve of 13 Scandinavian pediatric surgical centers participated in the study. During a 4-year period (1995 through 1998) 195 children with CDH were included. The main endpoints were hospital mortality rate and total mortality rate (before 2001). Bivariate and multivariate survival analyses were performed using Kaplan-Meier plots, Log-rank test, and Cox regression. RESULTS: Overall hospital mortality rate was 30%. Among 168 neonates with symptoms within 24 hours (early presenters) 35% died before discharge. All 61 deaths occurred in 157 neonates with symptoms within the first 2 hours of life. Among early presenters, 27% had prenatal ultrasound diagnosis, 26% were delivered by cesarean section, and 21% had associated major malformations. Bivariate analysis of early presenters showed increased risk of death in neonates with prenatal diagnosis, associated anomalies, right-sided diaphragmatic hernia (RCDH), low 1-minute and 5-minute Apgar scores, low birth weight, short gestational age, and cesarean delivery. Neonates with prenatal diagnosis were characterized by significantly lower Apgar scores, lower birth weight, and increased frequency of associated anomalies than those diagnosed after birth. Multivariate analysis found that prenatal diagnosis (P =.004), 1-minute Apgar (P =.001), and RCDH (P =.042) were independent predictors of total mortality rate. CONCLUSIONS: In a series of 195 CDH patients, all 61 deaths occurred in the 157 neonates presenting with symptoms within the first 2 hours of life. Prenatal diagnosis, 1-minute Apgar score, and RCDH were significant independent predictors of total mortality. J Pediatr Surg 37:1269-1275. Copyright 2002, Elsevier Science (USA). All rights reserved. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Pediatric Surgery
volume
37
issue
9
pages
1269 - 1275
publisher
Elsevier
external identifiers
  • pmid:12194115
  • wos:000177881400005
  • scopus:0036728424
ISSN
1531-5037
DOI
10.1053/jpsu.2002.34980
language
English
LU publication?
yes
id
10510675-5fc8-42e7-9257-2c3c36789e46 (old id 110072)
alternative location
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12194115&dopt=Abstract
date added to LUP
2007-07-19 13:31:35
date last changed
2017-12-10 03:41:00
@article{10510675-5fc8-42e7-9257-2c3c36789e46,
  abstract     = {BACKGROUND/PURPOSE: There is a lack of large contemporary studies on the management of congenital diaphragmatic hernia (CDH), and the prediction of mortality remains difficult. The aim of this study was to investigate the influence of perinatal factors on mortality rate in a contemporary multicenter study. METHODS: The authors conducted a retrospective multicenter cohort study. Twelve of 13 Scandinavian pediatric surgical centers participated in the study. During a 4-year period (1995 through 1998) 195 children with CDH were included. The main endpoints were hospital mortality rate and total mortality rate (before 2001). Bivariate and multivariate survival analyses were performed using Kaplan-Meier plots, Log-rank test, and Cox regression. RESULTS: Overall hospital mortality rate was 30%. Among 168 neonates with symptoms within 24 hours (early presenters) 35% died before discharge. All 61 deaths occurred in 157 neonates with symptoms within the first 2 hours of life. Among early presenters, 27% had prenatal ultrasound diagnosis, 26% were delivered by cesarean section, and 21% had associated major malformations. Bivariate analysis of early presenters showed increased risk of death in neonates with prenatal diagnosis, associated anomalies, right-sided diaphragmatic hernia (RCDH), low 1-minute and 5-minute Apgar scores, low birth weight, short gestational age, and cesarean delivery. Neonates with prenatal diagnosis were characterized by significantly lower Apgar scores, lower birth weight, and increased frequency of associated anomalies than those diagnosed after birth. Multivariate analysis found that prenatal diagnosis (P =.004), 1-minute Apgar (P =.001), and RCDH (P =.042) were independent predictors of total mortality rate. CONCLUSIONS: In a series of 195 CDH patients, all 61 deaths occurred in the 157 neonates presenting with symptoms within the first 2 hours of life. Prenatal diagnosis, 1-minute Apgar score, and RCDH were significant independent predictors of total mortality. J Pediatr Surg 37:1269-1275. Copyright 2002, Elsevier Science (USA). All rights reserved.},
  author       = {Skari, Hans and Bjornland, Kristin and Frenckner, Bjorn and Friberg, Lars and Heikkinen, Marja and Hurme, Timo and Loe, Borger and Mollerlokken, Gunnhild and Nielsen, Ole and Qvist, Niels and Rintala, Risto and Sandgren, Katarina and Wester, Tomas and Emblem, Ragnhild},
  issn         = {1531-5037},
  language     = {eng},
  number       = {9},
  pages        = {1269--1275},
  publisher    = {Elsevier},
  series       = {Journal of Pediatric Surgery},
  title        = {Congenital diaphragmatic hernia in Scandinavia from 1995 to 1998: Predictors of mortality.},
  url          = {http://dx.doi.org/10.1053/jpsu.2002.34980},
  volume       = {37},
  year         = {2002},
}