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Risk factors for congenital diaphragmatic hernia in the Bogota birth defects surveillance and follow-up program, Colombia

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Abstract

Purpose

The mortality rate for congenital diaphragmatic hernia (CDH) remains high and prevention efforts are limited by the lack of known risk factors. The aim of this study was to determine prevalence, risk factors, and neonatal results associated with CDH on a surveillance system hospital-based in Bogotá, Colombia.

Methods

The data used in this study were obtained from The Bogota Birth Defects Surveillance and Follow-up Program (BBDSFP), between January 2001 and December 2013. With 386,419 births, there were 81 cases of CDH. A case–control methodology was conducted with 48 of the total cases of CDH and 192 controls for association analysis.

Results

The prevalence of CDH was 2.1 per 10,000 births. In the case–control analysis, risk factors found were maternal age ≥35 years (OR, 33.53; 95 % CI, 7.02–160.11), infants with CDH were more likely to be born before 37 weeks of gestation (OR, 5.57; 95 % CI, 2.05–15.14), to weigh less than 2500 g at birth (OR, 9.05; 95 % CI, 3.51–23.32), and be small for gestational age (OR, 5.72; 95 % CI, 2.18–14.99) with a high rate of death before hospital discharge in the CDH population (CDH: 38 % vs BBDSFP: <1 %; p < 0.001).

Conclusions

The prevalence of CDH calculated was similar to the one reported in the literature. CDH is strongly associated with a high rate of death before hospital discharge and the risk factors found were maternal age ≥35 years, preterm birth, be small for gestational age, and have low weight at birth. These neonatal characteristics in developing countries would help to identify early CDH. Prevention efforts have been limited by the lack of known risk factors and established epidemiological profiles, especially in developing countries.

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Abbreviations

CDH:

Congenital diaphragmatic hernia

BBDSFP:

The Bogota Birth Defects Surveillance and Follow-up Program

BMI:

Maternal Body Mass Index

CNS:

Central nervous system

ECLAMC:

Latin American Collaborative Study of Congenital Malformations

ICBDSR:

International Clearinghouse for Birth Defects Surveillance and Research

ECMO:

Extracorporeal membrane oxygenation

References

  1. EUROCAT Central Registry, University of Ulster (2008) Statistical monitoring report. OIP EUROCAT: European Surveillance of Congenital Anomalies. http://www.eurocat-network.eu/pubdata/. Accessed 09 July 2015

  2. Correa-Villaseñor A, Cragan J, Kucik J et al (2003) The metropolitan Atlanta congenital defects program: 35 years of birth defects surveillance at the centers for disease control and prevention. Birth Defects Res A Clin Mol Teratol 67(9):617–624

    Article  PubMed  Google Scholar 

  3. Slavotinek AM (2005) The genetics of congenital diaphragmatic hernia. Semin Perinatol 29(2):77–85

    Article  PubMed  Google Scholar 

  4. Van den Hout L, Schaible T, Cohen-Overbeek TE et al (2011) Actual outcome in infants with congenital diaphragmatic hernia: the role of a standardized postnatal treatment protocol. Fetal Diagn Ther 29(1):55–63. doi:10.1159/000322694

    Article  PubMed  Google Scholar 

  5. Kotecha S, Barbato A, Bush A et al (2012) Congenital diaphragmatic hernia. ERJ 39(4):820–829. doi:10.1183/09031936.00066511

    Article  CAS  Google Scholar 

  6. Keijzer R, Puri P (2010) Congenital diaphragmatic hernia. Semin Pediatr Surg 19(3):180–185

    Article  PubMed  Google Scholar 

  7. Knoxa E, Lissauer D, Khan K et al (2010) Prenatal detection of pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis of diagnostic studies. J Matern Fet Neonat Med 23(7):579–588. doi:10.3109/14767050903551400

    Article  Google Scholar 

  8. Sandaite I, Claus F, De Keyzer F et al (2011) Examining the relationship between the lung-to-head ratio measured on ultrasound and lung volumetry by magnetic resonance in fetuses with isolated congenital diaphragmatic hernia. Fetal Diagn Ther 29:80–87. doi:10.1159/000320204

    Article  PubMed  Google Scholar 

  9. Jani J, Nicolaides KH, Keller RL et al (2007) Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obs Gynecol 30(1):67–71

    Article  CAS  Google Scholar 

  10. Laudy JA, Van Gucht M, Van Dooren MF et al (2003) Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters. Prenat Diagn 23(8):634

    Article  CAS  PubMed  Google Scholar 

  11. Lazar DA, Cass DL, Rodriguez MA et al (2011) Impact of prenatal evaluation and protocol-based perinatal management on congenital diaphragmatic hernia outcomes. J Pediatr Surg 46(5):808–813. doi:10.1016/jpedsurg.2011.02.009

    Article  PubMed  Google Scholar 

  12. Metkus AP, Filly RA, Stringer MD et al (1996) Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 31(1):148–151

    Article  CAS  PubMed  Google Scholar 

  13. Pober BR (2008) Genetic aspects of human congenital diaphragmatic hernia. Clin Genet 74(1):1–15. doi:10.1111/j.1399-0004.2008.01031

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Taylor GA, Atalabi OM, Estroff JA (2009) Imaging of congenital diaphragmatic hernias. Pediatr Radiol 39(1):1–16

    Article  PubMed  Google Scholar 

  15. Witters I, Legius E, Moerman P et al (2001) Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphragmatic hernia. Am J Med Genet 103(4):278–282

    Article  CAS  PubMed  Google Scholar 

  16. Balayla J, Abenhaim HA (2014) Incidence, predictors and outcomes of congenital diaphragmatic hernia: a population-based study of 32 million births in the United States. J Matern Neonatal Med 27(14):1438–1444. doi:10.3109/14767058.2013.858691

    Article  Google Scholar 

  17. Pironi D, Palazzini G, Arcieri S et al (2008) Laparoscopic diagnosis and treatment of diaphragmatic Morgagni hernia. Case report and review of the literature. Ann Ital di Chir 79(1):29–36

  18. Mitanchez D (2008) Antenatal treatment of congenital diaphragmatic hernia: an update. Arch Pediatr 15(8):1320–1325. doi:10.1016/j.arcped.2008.04.034

    Article  CAS  PubMed  Google Scholar 

  19. Poletta FA, Gili JA, Castilla EE (2014) Latin American collaborative study of congenital malformations (ECLAMC): a model for health collaborative studies. Public Health Genom 17(2):61–67. doi:10.1159/000356568

  20. ICBDSR: International Clearinghouse for Birth Defects Surveillance and Research (2014). http://www.icbdsr.org/page.asp?p=9895&l=1. Accessed 09 July 2015

  21. Langlois PH, Marengo LK, Canfield MA (2011) Time trends in the prevalence of birth defects in Texas 1999–2007: real or artifactual? Birth Defects Res Part A Clin Mol Teratol 91(10):902–917. doi:10.1002/bdra.22847

    Article  CAS  PubMed  Google Scholar 

  22. Kim K, Wang Y, Kirby RS et al (2013) Prevalence and trends of selected congenital malformations in New York state, 1983 to 2007. Birth Defects Res A Clin Mol Teratol 97(10):619–627

    Article  CAS  PubMed  Google Scholar 

  23. Loane M, Dolk H, Kelly A et al (2011) Paper 4: EUROCAT statistical monitoring: identification and investigation of ten year trends of congenital anomalies in Europe. Birth Defects Res A Clin Mol Teratol 91(1):S31–S43. doi:10.1002/bdra.20778

    Article  CAS  PubMed  Google Scholar 

  24. Levison J, Halliday R, Holland AJ et al (2006) A population-based study of congenital diaphragmatic hernia outcome in New South Wales and the Australian Capital Territory, Australia, 1992–2001. J Pediatr Surg 41:1049–1053

    Article  PubMed  Google Scholar 

  25. García M, Imbachí L, Hurtado P et al (2014) Detección ecográfica de anomalías congénitas en 76.155 nacimientos en Bogotá y Cali, 2011–2012. Biomédica 34:379–386

    Article  PubMed  Google Scholar 

  26. Downard CD, Jaksic T, Garza JJ et al (2003) Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg 38(5):729–732

    Article  PubMed  Google Scholar 

  27. Tsao K, Allison ND, Harting MT et al (2010) Congenital diaphragmatic hernia in the preterm infant. Surgery 148(2):404–410. doi:10.1016/j.surg.2010.03.018

    Article  PubMed Central  PubMed  Google Scholar 

  28. Lee SY, Tan KH (2013) Antenatally diagnosed congenital diaphragmatic hernia in Singapore: a five-year series. Singapore Med J 54(8):432–436

    Article  PubMed  Google Scholar 

  29. Safavi A, Lin Y, Skarsgard ED, Network Canadian Pediatric Surgery (2010) Perinatal management of congenital diaphragmatic hernia: when and how should babies be delivered? Results from the Canadian pediatric surgery network. J Pediatr Surg 45(12):2334–2339. doi:10.1016/j.jpedsurg.2010.08.026

    Article  PubMed  Google Scholar 

  30. Bhat YR, Kumar V, Rao A (2008) Congenital diaphragmatic hernia in a developing country, Singapore. Singapore Med J 49(9):715–718

    CAS  PubMed  Google Scholar 

  31. Gallot D, Boda C, Ughetto S et al (2007) Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol 29(3):276–283

    Article  CAS  PubMed  Google Scholar 

  32. Wright JC, Budd JL, Field DJ et al (2011) Epidemiology and outcome of congenital diaphragmatic hernia: a 9-year experience. Paediatr Perinat Epidemiol 25(2):144–149. doi:10.1111/j.1365-3016.2010.01172

    Article  PubMed  Google Scholar 

  33. Colvin J, Bower C, Dickinson JE et al (2005) Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 116(3):e356–e363

    Article  PubMed  Google Scholar 

  34. Dott MM, Wong LY, Rasmussen SA (2003) Population-based study of congenital diaphragmatic hernia: risk factors and survival in metropolitan Atlanta, 1968–1999. Birth Defects Res A Clin Mol Teratol 67:261–267

    Article  CAS  PubMed  Google Scholar 

  35. Tovar JA (2012) Congenital diaphragmatic hernia. Review article. Orphanet J Rare Dis 7:1. doi:10.1186/1750-1172-7-1

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Instituto de Genética Humana, Pontificia Universidad Javeriana, Carrera 7 no. 40-62 edificio 32, Bogotá, 110231, Colombia

    Ana M. García & I. M. Zarante

  2. Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 no. 40-62, Bogotá, 110231, Colombia

    S. Machicado

  3. Secretaría de Salud de Bogotá, Carrera 32 no. 12-81, Bogotá, 111611, Colombia

    G. Gracia

Authors
  1. Ana M. García
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  2. S. Machicado
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  3. G. Gracia
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  4. I. M. Zarante
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Corresponding author

Correspondence to Ana M. García.

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None of the authors have any proprietary interests or conflicts of interest related to this submission. All the authors state that this manuscript, figures or tables have not been published anywhere previously and that it is not simultaneously being considered for any other publication.

Financial support

Pontificia Universidad Javeriana Bogotá. Secretaría de Salud de Bogotá.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national 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.

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García, A.M., Machicado, S., Gracia, G. et al. Risk factors for congenital diaphragmatic hernia in the Bogota birth defects surveillance and follow-up program, Colombia. Pediatr Surg Int 32, 227–234 (2016). https://doi.org/10.1007/s00383-015-3832-7

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  • DOI: https://doi.org/10.1007/s00383-015-3832-7

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