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Outcomes of infants with congenital diaphragmatic hernia by side of defect in the FETO era

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Abstract

Purpose

To compare the outcomes of infants with a right (RCDH) versus a left-sided (LCDH) congenital diaphragmatic hernia (CDH) and whether these differed according to whether the infants had undergone fetoscopic tracheal occlusion (FETO).

Methods

Demographics, the type of surgical repair, preoperative and postoperative courses and respiratory, gastrointestinal, surgical and skeletal morbidities at follow-up were compared between infants with a RCDH or LCDH. A sub-analysis was undertaken in those who had undergone FETO.

Results

During the study period, there were 167 infants with a LCDH and 24 with a RCDH; 106 underwent FETO (15 RCDH). Overall, the need for inhaled nitric oxide (p = 0.036) was higher in the RCDH group and, at follow-up, infants with RCDH were more likely to have a hernia recurrence (p = 0.043), pectus deformity (p = 0.019), scoliosis (p = 0.029) and suffer chronic respiratory morbidity (p = 0.001). There were, however, no significant differences in short term or long term outcomes (hernia recurrence (p = 0.237), pectus deformity (p = 0.322), scoliosis (p = 0.0174) or chronic respiratory morbidity (p = 0.326)) between infants with a right or left sided CDH who had undergone FETO.

Conclusion

Overall, infants with a RCDH compared to those with a LCDH had greater long-term morbidity, but not if they had undergone FETO.

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Funding

This study was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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Authors and Affiliations

  1. Neonatal Intensive Care Centre, 4th Floor Golden Jubilee Wing, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK

    Kamal Ali, Theodore Dassios, Syed Abdul Khaliq, Kentaro Tamura & Anne Greenough

  2. Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Theodore Dassios, Emma E. Williams & Anne Greenough

  3. Division of Neonatology, Maternal and Perinatal Centre, Toyama University Hospital, Toyama, Japan

    Kentaro Tamura

  4. Department of Paediatric Surgery, King’s College Hospital NHS Foundation Trust, London, UK

    Mark Davenport

  5. The Asthma UK Centre for Allergic Mechanisms of Asthma, King’s College London, London, UK

    Anne Greenough

  6. NIHR Biomedical Centre at Guy’s and St Thomas NHS Foundation Trust and King’s College London, London, UK

    Anne Greenough

Authors
  1. Kamal Ali
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  2. Theodore Dassios
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  3. Syed Abdul Khaliq
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  4. Emma E. Williams
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  5. Kentaro Tamura
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  6. Mark Davenport
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  7. Anne Greenough
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Contributions

KA and AG designed the study. KA, SAK, EEW and KT collected the data. KA, TD, KA and AG undertook the analysis. All authors were involved in the production of the first draft of the manuscript and approved the final version.

Corresponding author

Correspondence to Anne Greenough.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

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

The audit was approved by the King’s College Hospital NHS Foundation Trust Clinical Audit Support System and, as it was not a research project, did not require informed parental consent.

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Ali, K., Dassios, T., Khaliq, S.A. et al. Outcomes of infants with congenital diaphragmatic hernia by side of defect in the FETO era. Pediatr Surg Int 35, 743–747 (2019). https://doi.org/10.1007/s00383-019-04484-3

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  • DOI: https://doi.org/10.1007/s00383-019-04484-3

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