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Appropriate timing of surgery for neonates with congenital diaphragmatic hernia: early or delayed repair?

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Abstract

Purpose

This study was aimed to evaluate the influence of timing of surgery on patient outcomes, and to clarify appropriate timing of surgery in neonates with congenital diaphragmatic hernia (CDH).

Methods

A total of 477 neonates with isolated CDH were included. Patients were classified into two groups by timing of surgery: early repair (ER) (≤48 h) and delayed repair (DR) (>48 h). The primary outcome was 90-day survival, with treatment duration (ventilation, oxygen, and hospitalization) being a secondary outcome. To adjust for disease severity, patients were stratified into three severities by Apgar score 1 min (“mild” 8–10, “moderate” 4–7, and “severe” 0–3), and outcomes were compared between ER and DR within each severity.

Results

Although 90-day survival was significantly different among the three severities (“mild” 97%, “moderate” 89%, and “severe” 76%, p = 0.002), there were no differences in 90-day survival between DR and ER within each severity. In “mild”, there were no differences in treatment duration between ER and DR. In “moderate”, treatment duration was shorter in ER than DR (ventilation 11 vs. 16 days, oxygen 15 vs. 20 days, and hospitalization 34 vs. 48 days). In “severe”, treatment duration was shorter in ER than DR, while the best OI was higher in DR than ER.

Conclusions

Timing of CDH repair seems to have no influence on 90-day survival regardless of disease severity. Patients with moderate severity may benefit from the early repair by reducing treatment duration.

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Acknowledgements

This work was supported by a Grant from The Ministry of Health, Labour and Welfare of Japan (H23-Nanchi-Ippan-051, Health and Labour Sciences Research Grants for Research on intractable diseases. The authors thank all the members of Japanese CDH study group and all the participant institutes in this study.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Hiroomi Okuyama

  2. Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

    Noriaki Usui

  3. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Masahiro Hayakawa

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

    Tomoaki Taguchi

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  1. Hiroomi Okuyama
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  2. Noriaki Usui
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  3. Masahiro Hayakawa
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  4. Tomoaki Taguchi
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Japanese CDH study group

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Correspondence to Hiroomi Okuyama.

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The authors declare that they have no conflict of interest.

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Okuyama, H., Usui, N., Hayakawa, M. et al. Appropriate timing of surgery for neonates with congenital diaphragmatic hernia: early or delayed repair?. Pediatr Surg Int 33, 133–138 (2017). https://doi.org/10.1007/s00383-016-4003-1

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  • DOI: https://doi.org/10.1007/s00383-016-4003-1

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