Presented at the Neonatal Society 2017 Autumn Meeting.
Tullie L1, Stedman F1, Keys C1, Burge D1, Hall N1,2
1 Department of Paediatric Surgery and Urology, Southampton Children’s Hospital
2 University Surgery Unit, Faculty of Medicine, University of Southampton
Background: There are few reports of outcomes of infants with congenital diaphragmatic hernia (CDH) born preterm. Intuitively this combination should be associated with poor prognosis. We aimed to describe clinical features and outcomes for preterm infants with CDH.
Methods: We conducted an institutionally approved, retrospective case-note review of all live-born infants with CDH over 20 years (1996-2016). Preterm infants were defined as born <37 completed weeks. Demographic and clinical data (median [range]) were analysed using Fishers exact and Mann-Whitney tests.
Results: During the study period, 136 live-born infants with CDH were treated. Overall survival was 75%. Twenty-nine (21%) were born preterm at median 35 weeks gestation (28-36). Compared to term infants, antenatal diagnosis (term 63/108 vs preterm 18/29; p=0.8) and survival (term 79/108 [74%] vs preterm 23/29 [79%]; p=0.6) was similar in preterms. There was a trend towards greater length of stay in survivors born preterm than those at term (16.5 days [7-75] vs 12 days [2-72]; p=0.06). Of 29 preterm infants, 18 were diagnosed antenatally (at 21 weeks gestation [19-25]), and 24 (83%) had left sided defects. Seventeen (59%) had evidence of significant pulmonary hypertension on echocardiogram. None received ECMO. Five of the preterm infants died without surgery; 1 with a non-survivable cardiac anomaly and 4 with refractory severe pulmonary hypertension. The remaining 24 underwent surgical repair (6 with patch). Total duration of ventilation was 6 days (0-36) and length of stay in survivors 16.5 days (7-75). There were no significant differences in clinical features for preterm infants who survived compared to those who died (Table).
Conclusion: These data suggest equivalent outcomes for preterm and term live-born infants with CDH. We report higher survival in preterms than other published series. Preterm infants with CDH should be actively managed despite their prematurity.
Corresponding author: ltullie@doctors.org.uk