An evaluation of the role of concomitant anomalies on the outcomes of fetuses with congenital diaphragmatic hernia

Adesola C. Akinkuotu, Stephanie M. Cruz, Darrell L. Cass, Timothy C. Lee, Christopher I. Cassady, Amy R. Mehollin-Ray, Rodrigo Ruano, Stephen E. Welty, Oluyinka O. Olutoye

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Purpose The purpose of this study was to evaluate the impact of various types of associated anomalies on CDH mortality and morbidity. Methods All CDH patients at a tertiary care center from January 2004 to January 2014 were reviewed retrospectively. Isolated CDH was defined as CDH without any associated anomalies. Cardiac anomalies were stratified into minor and major based on the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) scoring system. Other anatomic anomalies requiring intervention in the perinatal period were classified as major anomalies. The outcomes of interest were 6-month mortality as well as pulmonary and gastrointestinal morbidity. Results Of 189 CDH patients, 93 (49%) had isolated CDH. Others had: cardiac anomalies alone (n = 47, 25%), genetic anomalies (n = 28, 15%), structural anomalies alone (n = 18, 10%), and both cardiac and genetic anomalies (n = 20, 11%). Fifty (26.5%) patients were dead before six months of age. Mortality rate at 6 months was higher in patients with genetic and major cardiac anomalies. A major cardiac anomaly was independently associated with a 102-fold increased risk of mortality at 6 months (95%CI: 3.1-3402). Pulmonary morbidity was increased in patients with genetic, major cardiac, and major structural anomalies, while gastrointestinal morbidity was higher in patients with major structural anomalies alone. Conclusion Major cardiac and genetic anomalies were associated with increased 6-month mortality in CDH patients. However, the association with minor cardiac anomalies and/or structural anomalies did not affect mortality and morbidity of CDH patients. The presence of minor anomalies should not adversely impact their perinatal management or consideration for in-utero therapy.

Original languageEnglish (US)
Pages (from-to)714-717
Number of pages4
JournalJournal of Pediatric Surgery
Volume51
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

    Fingerprint

Keywords

  • Congenital anomalies
  • Congenital diaphragmatic hernia
  • Isolated CDH

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Akinkuotu, A. C., Cruz, S. M., Cass, D. L., Lee, T. C., Cassady, C. I., Mehollin-Ray, A. R., Ruano, R., Welty, S. E., & Olutoye, O. O. (2016). An evaluation of the role of concomitant anomalies on the outcomes of fetuses with congenital diaphragmatic hernia. Journal of Pediatric Surgery, 51(5), 714-717. https://doi.org/10.1016/j.jpedsurg.2016.02.008