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Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study

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Abstract

Purpose

This study aimed to elucidate the clinical characteristics of neonates with congenital diaphragmatic hernia (CDH) associated with pneumothorax and evaluate the risk factors for the development of pneumothorax.

Methods

A retrospective cohort study was conducted in the 15 institutions participating in the Japanese CDH Study Group. A total of 495 neonates with isolated CDH who were born between 2011 and 2018 were analyzed in this study.

Results

Among the 495 neonates with isolated CDH, 52 (10.5%) developed pneumothorax. Eighteen (34.6%) patients developed pneumothorax before surgery, while 34 (65.4%) developed pneumothorax after surgery. The log-rank test showed that the cumulative survival rate was significantly lower in patients with pneumothorax than in those without pneumothorax. Univariate analysis revealed significant differences between patients with pneumothorax and those without pneumothorax with regard to the best oxygenation index within 24 h after birth, mean airway pressure (MAP) higher than 16 cmH2O, diaphragmatic defect size, and need for patch closure. Multiple logistic regression analysis indicated that only the MAP was associated with an increased risk of pneumothorax.

Conclusions

The cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients.

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References

  1. Wung JT, Sahni R, Moffitt ST et al (1995) Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg 30(3):406–409

    Article  CAS  PubMed  Google Scholar 

  2. Finer NN, Tierney A, Etches PC et al (1998) Congenital diaphragmatic hernia: developing a protocolized approach. J Pediatr Surg 33(9):1331–1337

    Article  CAS  PubMed  Google Scholar 

  3. Kays DW, Langham MR Jr, Ledbetter DJ et al (1999) Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg 230(3):340–348 (discussion 348–351)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Migliazza L, Bellan C, Alberti D et al (2007) Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg 42(9):1526–1532

    Article  PubMed  Google Scholar 

  5. Waag KL, Loff S, Zahn K et al (2008) Congenital diaphragmatic hernia: a modern day approach. Semin Pediatr Surg 17(4):244–254

    Article  PubMed  Google Scholar 

  6. Al-Hathlol K, Elmahdy H, Nawaz S et al (2011) Perioperative course of pulmonary hypertension in infants with congenital diaphragmatic hernia: impact on outcome following successful repair. J Pediatr Surg 46(4):625–629

    Article  PubMed  Google Scholar 

  7. Usui N, Nagata K, Hayakawa M et al (2014) Pneumothoraces as a fatal complication of congenital diaphragmatic hernia in the era of gentle ventilation. Eur J Pediatr Surg 24(1):31–38

    PubMed  Google Scholar 

  8. Lally KP, Lasky RE, Lally PA et al (2013) Standardized reporting for congenital diaphragmatic hernia—an international consensus. J Pediatr Surg 48(12):2408–2415

    Article  PubMed  Google Scholar 

  9. Duong HH, Mirea L, Shah PS et al (2014) Pneumothorax in neonates: trends, predictors and outcomes. J Neonatal Perinatal Med 7(1):29–38

    Article  PubMed  Google Scholar 

  10. García-Muñoz Rodrigo F, Urquía Martí L, Galán Henríquez G et al (2017) Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants. J Matern Fetal Neonatal Med 30(22):2679–2685

    Article  PubMed  Google Scholar 

  11. Hadzic D, Skokic F, Husaric E et al (2019) Risk factors and outcome of neonatal pneumothorax in Tuzla Canton. Mater Sociomed 31(1):66–70

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jaroensri S, Kamolvisit W, Nakwan N (2019) Risk factor analysis of pneumothorax associated with persistent pulmonary hypertension of the newborn in Thai neonates. J Matern Fetal Neonatal Med 28:1–6

    Article  Google Scholar 

  13. Drummond WH, Gregory GA, Heymann MA et al (1981) The independent effects of hyperventilation, tolazoline, and dopamine on infants with persistent pulmonary hypertension. J Pediatr 98(4):603–611

    Article  CAS  PubMed  Google Scholar 

  14. Sakurai Y, Azarow K, Cutz E et al (1999) Pulmonary barotrauma in congenital diaphragmatic hernia: a clinicopathological correlation. J Pediatr Surg 34(12):1813–1817

    Article  CAS  PubMed  Google Scholar 

  15. Vanamo K, Rintala R, Sovijärvi A et al (1996) Long-term pulmonary sequelae in survivors of congenital diaphragmatic defects. J Pediatr Surg 31(8):1096–1099 (discussion 1099-1100)

    Article  CAS  PubMed  Google Scholar 

  16. Boloker J, Bateman DA, Wung JT et al (2002) Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg 37(3):357–366

    Article  PubMed  Google Scholar 

  17. Bagolan P, Casaccia G, Crescenzi F et al (2004) Impact of a current treatment protocol on outcome of high-risk congenital diaphragmatic hernia. J Pediatr Surg 39(3):313–318 (discussion 313–318)

    Article  CAS  PubMed  Google Scholar 

  18. Smith J, Schumacher RE, Donn SM et al (2011) Clinical course of symptomatic spontaneous pneumothorax in term and late preterm newborns: report from a large cohort. Am J Perinatol 28(2):163–168

    Article  PubMed  Google Scholar 

  19. Slutsky AS (1999) Lung injury caused by mechanical ventilation. Chest 116(1 Suppl):9S–15S

    Article  CAS  PubMed  Google Scholar 

  20. Vibede L, Vibede E, Bendtsen M et al (2017) Neonatal pneumothorax: a descriptive regional danish study. Neonatology 111(4):303–308

    Article  PubMed  Google Scholar 

  21. Gammon RB, Shin MS, Groves RH Jr et al (1995) Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Am J Respir Crit Care Med 152(4 Pt 1):1235–1240

    Article  CAS  PubMed  Google Scholar 

  22. Gattinoni L, Pesenti A (2005) The concept of “baby lung”. Intensive Care Med 31(6):776–784

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Murodoucho 840, Izumi, Osaka, 594-1101, Japan

    Kazunori Masahata & Noriaki Usui

  2. Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan

    Kouji Nagata & Tomoaki Taguchi

  3. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Keita Terui

  4. Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Masahiro Hayakawa

  5. Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan

    Shoichiro Amari

  6. Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kouji Masumoto

  7. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan

    Tadaharu Okazaki

  8. Department of Pediatrics, Kinki University, Faculty of Medicine, Osakasayama, Japan

    Noboru Inamura

  9. Department of Pediatric Surgery, Shizuoka Children’s Hospital, Shizuoka, Japan

    Naoto Urushihara

  10. Departments of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan

    Katsuaki Toyoshima

  11. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan

    Keiichi Uchida

  12. Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Taizo Furukawa

  13. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Manabu Okawada

  14. Departments of Pediatric Surgery, Kobe Children’s Medical Center, Kobe, Japan

    Akiko Yokoi

  15. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan

    Hiroomi Okuyama

Authors
  1. Kazunori Masahata
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  2. Noriaki Usui
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  3. Kouji Nagata
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  4. Keita Terui
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  5. Masahiro Hayakawa
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  6. Shoichiro Amari
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  7. Kouji Masumoto
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  8. Tadaharu Okazaki
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  9. Noboru Inamura
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  10. Naoto Urushihara
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  11. Katsuaki Toyoshima
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  12. Keiichi Uchida
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  13. Taizo Furukawa
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  14. Manabu Okawada
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  15. Akiko Yokoi
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  16. Hiroomi Okuyama
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  17. Tomoaki Taguchi
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Corresponding author

Correspondence to Kazunori Masahata.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. We would like to thank Editage (http://www.editage.com) for English editing.

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Masahata, K., Usui, N., Nagata, K. et al. Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study. Pediatr Surg Int 36, 669–677 (2020). https://doi.org/10.1007/s00383-020-04659-3

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  • DOI: https://doi.org/10.1007/s00383-020-04659-3

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