Journal article
Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility
Journal of pediatric surgery, v 48(5), pp 924-929
01 May 2013
PMID: 23701761
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Little is known about liveborn CDH patients who die without surgery. We audited a national CDH cohort to determine whether these patients were different from patients who received CDH repair.
A national CDH database was analyzed (2005–2009). After excluding infants with severe physiologic instability and genetic/congenital malformations, a potential surgical candidate (PSC) subgroup was identified. PSCs were compared to the operative group (OG) and the operative non-survivor (ONS) subgroup. Standard statistical analyses were performed.
Of 275 liveborns, 35 (13%) died without surgery. The PSC subgroup (n=11) had a median survival of 10days (range: 3–18). Ten of 11 PSC infants were treated in ECMO centers, with 4 receiving ECMO. No differences in BW, GA, and rates of minor malformation were observed between PSC and OG patients. While neonatal illness severity (SNAP-II) predicted overall mortality, SNAP-II scores were similar between PSC and ONS groups (34 vs. 29; p=0.431). Furthermore, greater than 80% of infants with SNAP-II scores between 30 and 39 survived in the OG cohort.
Our analysis demonstrated that PSCs were similar to infants offered surgery based on illness severity and the presence of congenital malformations. We suggest that criteria for surgical ineligibility be developed to standardize the selection of surgical candidates.
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Details
- Title
- Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility
- Creators
- Marnie Goodwin Wilson - Montreal Children's HospitalAlana Beres - Montreal Children's HospitalRobert Baird - Montreal Children's HospitalJean-Martin Laberge - Montreal Children's HospitalErik D. Skarsgard - British Columbia Children's HospitalPramod S. Puligandla - Montreal Children's HospitalThe Canadian Pediatric Surgery Network
- Publication Details
- Journal of pediatric surgery, v 48(5), pp 924-929
- Publisher
- Elsevier
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000320372100015
- Scopus ID
- 2-s2.0-84878000867
- Other Identifier
- 991021969474304721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Pediatrics
- Surgery