Revisiting outcomes of right congenital diaphragmatic hernia

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

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Studies comparing outcomes of right- and left-sided congenital diaphragmatic hernia (R-CDH and L-CDH) have yielded conflicting results. We hypothesized that R-CDH is associated with higher short-term pulmonary morbidity than L-CDH. Methods We reviewed all CDH patients at a tertiary children's hospital over 10 y. In prenatally diagnosed CDH, the observed-to-expected total fetal lung volume and percentage liver herniation (%LH) were calculated using fetal magnetic resonance imaging-based measurements. Outcomes were compared in patients with isolated CDH. Patients were subsequently matched by %LH to compare outcomes. Results Of 189 CDH patients, 37 (20.1 %) were R-CDH and 147 (79.9%) were L-CDH. Those with R-CDH were prenatally diagnosed at a significantly lower rate (40.5% versus 73.5%; P < 0.001) and later gestational age (26.5 ± 7.7 versus 22.6 ± 5.65 wk; P = 0.062). There was no difference in observed-to-expected total fetal lung volume between those with R-CDH and L-CDH (30.2 ± 11.1% versus 33.1 ± 14.2%; P = 0.471). Fetuses with R-CDH had a higher %LH than those with L-CDH (37.5 ± 14.1% versus 18.6 ± 12.2%; P < 0.001). Patients with isolated R-CDH had a higher need for extracorporeal membrane oxygenation than L-CDH (48% versus 27%; P = 0.055). There was no difference in duration of tracheal intubation, hospital stay, need for supplemental oxygen at 30-d of life or 6-mo mortality between groups. There was no difference in mortality and pulmonary morbidity when patients were matched by %LH. Conclusions Compared to those with L-CDH, fetuses with R-CDH are less likely to be diagnosed prenatally and have a higher need for extracorporeal membrane oxygenation. The sidedness of the hernia defect was not associated with differences in short-term pulmonary morbidity in this large, contemporary single-institution experience of neonates with CDH.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalJournal of Surgical Research
Volume198
Issue number2
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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Lung
Extracorporeal Membrane Oxygenation
Morbidity
Fetus
Mortality
Hernia
Intubation
Tertiary Care Centers
Gestational Age
Congenital Diaphragmatic Hernias
Length of Stay
Magnetic Resonance Imaging
Outcome Assessment (Health Care)
Newborn Infant
Oxygen
Liver

Keywords

  • Liver herniation
  • Right congenital diaphragmatic hernia

ASJC Scopus subject areas

  • Surgery

Cite this

Akinkuotu, A. C., Cruz, S. M., Cass, D. L., Cassady, C. I., Mehollin-Ray, A. R., Williams, J. L., ... Olutoye, O. O. (2015). Revisiting outcomes of right congenital diaphragmatic hernia. Journal of Surgical Research, 198(2), 413-417. https://doi.org/10.1016/j.jss.2015.03.090

Revisiting outcomes of right congenital diaphragmatic hernia. / Akinkuotu, Adesola C.; Cruz, Stephanie M.; Cass, Darrell L.; Cassady, Christopher I.; Mehollin-Ray, Amy R.; Williams, Jennifer L.; Lee, Timothy C.; Ruano, Rodrigo; Welty, Stephen E.; Olutoye, Oluyinka O.

In: Journal of Surgical Research, Vol. 198, No. 2, 01.10.2015, p. 413-417.

Research output: Contribution to journalArticle

Akinkuotu, AC, Cruz, SM, Cass, DL, Cassady, CI, Mehollin-Ray, AR, Williams, JL, Lee, TC, Ruano, R, Welty, SE & Olutoye, OO 2015, 'Revisiting outcomes of right congenital diaphragmatic hernia', Journal of Surgical Research, vol. 198, no. 2, pp. 413-417. https://doi.org/10.1016/j.jss.2015.03.090
Akinkuotu AC, Cruz SM, Cass DL, Cassady CI, Mehollin-Ray AR, Williams JL et al. Revisiting outcomes of right congenital diaphragmatic hernia. Journal of Surgical Research. 2015 Oct 1;198(2):413-417. https://doi.org/10.1016/j.jss.2015.03.090
Akinkuotu, Adesola C. ; Cruz, Stephanie M. ; Cass, Darrell L. ; Cassady, Christopher I. ; Mehollin-Ray, Amy R. ; Williams, Jennifer L. ; Lee, Timothy C. ; Ruano, Rodrigo ; Welty, Stephen E. ; Olutoye, Oluyinka O. / Revisiting outcomes of right congenital diaphragmatic hernia. In: Journal of Surgical Research. 2015 ; Vol. 198, No. 2. pp. 413-417.
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abstract = "Background Studies comparing outcomes of right- and left-sided congenital diaphragmatic hernia (R-CDH and L-CDH) have yielded conflicting results. We hypothesized that R-CDH is associated with higher short-term pulmonary morbidity than L-CDH. Methods We reviewed all CDH patients at a tertiary children's hospital over 10 y. In prenatally diagnosed CDH, the observed-to-expected total fetal lung volume and percentage liver herniation ({\%}LH) were calculated using fetal magnetic resonance imaging-based measurements. Outcomes were compared in patients with isolated CDH. Patients were subsequently matched by {\%}LH to compare outcomes. Results Of 189 CDH patients, 37 (20.1 {\%}) were R-CDH and 147 (79.9{\%}) were L-CDH. Those with R-CDH were prenatally diagnosed at a significantly lower rate (40.5{\%} versus 73.5{\%}; P < 0.001) and later gestational age (26.5 ± 7.7 versus 22.6 ± 5.65 wk; P = 0.062). There was no difference in observed-to-expected total fetal lung volume between those with R-CDH and L-CDH (30.2 ± 11.1{\%} versus 33.1 ± 14.2{\%}; P = 0.471). Fetuses with R-CDH had a higher {\%}LH than those with L-CDH (37.5 ± 14.1{\%} versus 18.6 ± 12.2{\%}; P < 0.001). Patients with isolated R-CDH had a higher need for extracorporeal membrane oxygenation than L-CDH (48{\%} versus 27{\%}; P = 0.055). There was no difference in duration of tracheal intubation, hospital stay, need for supplemental oxygen at 30-d of life or 6-mo mortality between groups. There was no difference in mortality and pulmonary morbidity when patients were matched by {\%}LH. Conclusions Compared to those with L-CDH, fetuses with R-CDH are less likely to be diagnosed prenatally and have a higher need for extracorporeal membrane oxygenation. The sidedness of the hernia defect was not associated with differences in short-term pulmonary morbidity in this large, contemporary single-institution experience of neonates with CDH.",
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AU - Akinkuotu, Adesola C.

AU - Cruz, Stephanie M.

AU - Cass, Darrell L.

AU - Cassady, Christopher I.

AU - Mehollin-Ray, Amy R.

AU - Williams, Jennifer L.

AU - Lee, Timothy C.

AU - Ruano, Rodrigo

AU - Welty, Stephen E.

AU - Olutoye, Oluyinka O.

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N2 - Background Studies comparing outcomes of right- and left-sided congenital diaphragmatic hernia (R-CDH and L-CDH) have yielded conflicting results. We hypothesized that R-CDH is associated with higher short-term pulmonary morbidity than L-CDH. Methods We reviewed all CDH patients at a tertiary children's hospital over 10 y. In prenatally diagnosed CDH, the observed-to-expected total fetal lung volume and percentage liver herniation (%LH) were calculated using fetal magnetic resonance imaging-based measurements. Outcomes were compared in patients with isolated CDH. Patients were subsequently matched by %LH to compare outcomes. Results Of 189 CDH patients, 37 (20.1 %) were R-CDH and 147 (79.9%) were L-CDH. Those with R-CDH were prenatally diagnosed at a significantly lower rate (40.5% versus 73.5%; P < 0.001) and later gestational age (26.5 ± 7.7 versus 22.6 ± 5.65 wk; P = 0.062). There was no difference in observed-to-expected total fetal lung volume between those with R-CDH and L-CDH (30.2 ± 11.1% versus 33.1 ± 14.2%; P = 0.471). Fetuses with R-CDH had a higher %LH than those with L-CDH (37.5 ± 14.1% versus 18.6 ± 12.2%; P < 0.001). Patients with isolated R-CDH had a higher need for extracorporeal membrane oxygenation than L-CDH (48% versus 27%; P = 0.055). There was no difference in duration of tracheal intubation, hospital stay, need for supplemental oxygen at 30-d of life or 6-mo mortality between groups. There was no difference in mortality and pulmonary morbidity when patients were matched by %LH. Conclusions Compared to those with L-CDH, fetuses with R-CDH are less likely to be diagnosed prenatally and have a higher need for extracorporeal membrane oxygenation. The sidedness of the hernia defect was not associated with differences in short-term pulmonary morbidity in this large, contemporary single-institution experience of neonates with CDH.

AB - Background Studies comparing outcomes of right- and left-sided congenital diaphragmatic hernia (R-CDH and L-CDH) have yielded conflicting results. We hypothesized that R-CDH is associated with higher short-term pulmonary morbidity than L-CDH. Methods We reviewed all CDH patients at a tertiary children's hospital over 10 y. In prenatally diagnosed CDH, the observed-to-expected total fetal lung volume and percentage liver herniation (%LH) were calculated using fetal magnetic resonance imaging-based measurements. Outcomes were compared in patients with isolated CDH. Patients were subsequently matched by %LH to compare outcomes. Results Of 189 CDH patients, 37 (20.1 %) were R-CDH and 147 (79.9%) were L-CDH. Those with R-CDH were prenatally diagnosed at a significantly lower rate (40.5% versus 73.5%; P < 0.001) and later gestational age (26.5 ± 7.7 versus 22.6 ± 5.65 wk; P = 0.062). There was no difference in observed-to-expected total fetal lung volume between those with R-CDH and L-CDH (30.2 ± 11.1% versus 33.1 ± 14.2%; P = 0.471). Fetuses with R-CDH had a higher %LH than those with L-CDH (37.5 ± 14.1% versus 18.6 ± 12.2%; P < 0.001). Patients with isolated R-CDH had a higher need for extracorporeal membrane oxygenation than L-CDH (48% versus 27%; P = 0.055). There was no difference in duration of tracheal intubation, hospital stay, need for supplemental oxygen at 30-d of life or 6-mo mortality between groups. There was no difference in mortality and pulmonary morbidity when patients were matched by %LH. Conclusions Compared to those with L-CDH, fetuses with R-CDH are less likely to be diagnosed prenatally and have a higher need for extracorporeal membrane oxygenation. The sidedness of the hernia defect was not associated with differences in short-term pulmonary morbidity in this large, contemporary single-institution experience of neonates with CDH.

KW - Liver herniation

KW - Right congenital diaphragmatic hernia

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