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The efficacy of the postnatal nasogastric tube position as a prognostic marker of left-sided isolated congenital diaphragmatic hernia

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Abstract

Purpose

The prenatal diagnosis of the stomach position in congenital diaphragmatic hernia (CDH) has been a reliable prognostic factor, but few studies have focused on the postnatal position. We therefore evaluated the significance of the nasogastric (NG) tube position just after birth.

Methods

The Japanese CDH Study Group database enrolled 1037 CDH neonates over 15 years. In our multicenter retrospective study, 464 cases of left-sided isolated CDH with prenatal diagnoses were divided into two groups: NG tube below the diaphragm (BD; n = 190) or above the diaphragm (AD; n = 274). The primary outcome was the 90-day survival rate, and the secondary outcomes were mechanical ventilation duration, hospitalization duration, and recurrence rate.

Results

The BD group had a significantly higher 90-day survival rate (98.4 vs. 89.4%, p < 0.001), shorter mechanical ventilation (11 vs. 19 days, p < 0.001), shorter hospitalization (38 vs. 59 days, p < 0.001), and lower recurrence rate (p = 0.002) than the AD group. A multivariate analysis showed that BD (adjusted odds ratio, 3.68; 95% confidence interval 1.02–13.30) was a favorable prognostic factor for the 90-day survival.

Conclusion

The assessment of the NG tube position revealed it to be a reliable prognostic factor of left-sided isolated CDH. Therefore, it should be included as a routine assessment.

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Code availability

The datasets in this study are available from the corresponding author upon reasonable request.

Abbreviations

CDH:

Congenital diaphragmatic hernia

NG:

Nasogastric

BD:

Below diaphragm

AD:

Above diaphragm

LHR:

Lung area-to-head circumference ratio

o/eLHR:

Observed/expected lung area-to-head circumference ratio

LTR:

Lung-to-thorax transverse ratio

OI:

Oxygenation index

iNO:

Inhaled nitric oxide

ECMO:

Extracorporeal membrane oxygenation

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgements

We thank Brian Quinn for English language editing. We also thank all members of the Japanese CDHSG for their commitments to CDH research.

Funding

This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan (Program Grant Number 20FC1017).

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan

    Jun Kono, Kouji Nagata & Tatsuro Tajiri

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

    Keita Terui

  3. Division of Neonatology, National Center for Child Health and Development, Setagaya-Ku, Japan

    Shoichiro Amari

  4. Department of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan

    Katsuaki Toyoshima

  5. Department of Pediatrics, Kinki University, Higashiosaka, Japan

    Noboru Inamura

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

    Yuhki Koike

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

    Masaya Yamoto

  8. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan

    Tadaharu Okazaki

  9. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Japan

    Yuta Yazaki

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

    Hiroomi Okuyama

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

    Masahiro Hayakawa

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

    Taizo Furukawa

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

    Kouji Masumoto

  14. Department of Pediatric Surgery, Hyogo Children’s Hospital, Hyogo, Japan

    Akiko Yokoi

  15. Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Izumi, Japan

    Noriaki Usui

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  1. Jun Kono
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  2. Kouji Nagata
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Contributions

KN: designed the study and JK: analyzed the data, and wrote the draft on the manuscript. KT, SA, KT, NI, YK, MY, TO, YY, HO, MH, TF, KM, AY, NU: contributed to the data collection, data cleaning, interpretation. KT, KT, HO, NU, and TT: critically reviewed this manuscript. The final version of the manuscript was approved by all authors.

Corresponding author

Correspondence to Kouji Nagata.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

This study was approved by the ethics committee of Kyushu University (Ethical approval number 2020-759) and an institutional review board of all participating institutions.

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Kono, J., Nagata, K., Terui, K. et al. The efficacy of the postnatal nasogastric tube position as a prognostic marker of left-sided isolated congenital diaphragmatic hernia. Pediatr Surg Int 38, 1873–1880 (2022). https://doi.org/10.1007/s00383-022-05226-8

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