Outcomes of congenital diaphragmatic hernia in the modern era of management.
Outcomes of congenital diaphragmatic hernia in the modern era of management.
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DOI：
10.1016/j.jpeds.2012.12.036
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发表时间：
2013-07-01
期刊：
影响因子：
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通讯作者：
Arkovitz, Marc S
中科院分区：
文献类型：
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作者：
Wynn, Julia;Krishnan, Usha;Arkovitz, Marc S
目的：探讨先天性横隔疝(CDH)患者发生肺动脉高压(PH)和死亡率的临床相关因素。研究设计：对7个合作医疗中心中的1个确诊为横隔膜缺陷的新生儿进行前瞻性队列研究。分别在1个月和3个月龄时进行超声心动图检查，并由2名心脏病专家在中心进行分析。应用Fischer精确检验、CHI(2)和回归分析，检验PH程度和生存率与临床变量的相关性。结果：220例患者符合纳入标准。出生1个月时测得的PH值越差，死亡率越高。其他与死亡率相关的因素是需要进行体外膜肺氧合，在治疗中心出生的患者，以及产前诊断为CDH的患者。有趣的是，右侧CDH的患者没有更差的结果。结论：PH的严重程度与CDH的死亡率有关。其他与死亡率相关的因素包括出生体重、出生时胎龄、出生状态和是否需要体外膜氧合。
OBJECTIVE: To identify clinical factors associated with pulmonary hypertension (PH) and mortality in patients with congenital diaphragmatic hernia (CDH).STUDY DESIGN: A prospective cohort of neonates with a diaphragm defect identified at 1 of 7 collaborating medical centers was studied. Echocardiograms were performed at 1 month and 3 months of age and analyzed at a central core by 2 cardiologists independently. Degree of PH and survival were tested for association with clinical variables using Fischer exact test, chi(2), and regression analysis.RESULTS: Two hundred twenty patients met inclusion criteria. Worse PH measured at 1 month of life was associated with higher mortality. Other factors associated with mortality were need for extracorporeal membrane oxygenation, patients inborn at the treating center, and patients with a prenatal diagnosis of CDH. Interestingly, patients with right sided CDH did not have worse outcomes.CONCLUSIONS: Severity of PH is associated with mortality in CDH. Other factors associated with mortality were birth weight, gestational age at birth, inborn status, and need for extracorporeal membrane oxygenation.