Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 494-502 (doi:10.1542/peds.2008-0528)
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ARTICLE

Timing of Delivery and Survival Rates for Infants With Prenatal Diagnoses of Congenital Diaphragmatic Hernia

Timothy P. Stevens, MD, MPHa, Edwin van Wijngaarden, PhDb, Kate G. Ackerman, MDc, Pamela A. Lally, MDd,e, Kevin P. Lally, MDd,e for the Congenital Diaphragmatic Hernia Study Group

a Department of Pediatrics, Division of Neonatology
b Departments of Epidemiology
c Pediatric Critical Care, University of Rochester, Rochester, New York
d Departments of Pediatric Surgery
e Surgery, University of Texas Medical School Houston and Children's Memorial Hermann Hospital, Houston, Texas

OBJECTIVES. The goal of the study was to test the hypothesis that infants with known congenital diaphragmatic hernias born at early term gestation (37–38 weeks) rather than later (39–41 weeks) had greater survival rates and less extracorporeal membrane oxygenation use. Primary outcomes were survival to hospital discharge or transfer and extracorporeal membrane oxygenation use.

METHODS. A retrospective cohort study of term infants with prenatal diagnoses of congenital diaphragmatic hernia was performed with the Congenital Diaphragmatic Hernia Study Group Registry of patients with congenital diaphragmatic hernias who were treated between January 1995 and December 2006.

RESULTS. Among 628 term infants at 37 to 41 weeks of gestation who had prenatal diagnoses of congenital diaphragmatic hernia and were free of major associated anomalies, early term birth (37 vs 39–41 weeks) and greater birth weight were associated independently with survival, whereas black race was related inversely to survival. Infants born at early term with birth weights at or above the group mean (3.1 kg) had the greatest survival rate (80%). Among infants born through elective cesarean delivery, infants born at 37 to 38 weeks of gestation, compared with 39 to 41 weeks, had less use of extracorporeal membrane oxygenation (22.0% vs 35.5%) and a trend toward a greater survival rate (75.0% vs 65.8%).

CONCLUSIONS. The timing of delivery is an independent, potentially important factor in the consideration of elective delivery for infants diagnosed prenatally as having congenital diaphragmatic hernias. Among fetuses with prenatally diagnosed congenital diaphragmatic hernias and without major associated anomalies, early term delivery may confer advantage.

Key Words: congenital diaphragmatic hernia • extracorporeal membrane oxygenation • survival • gestational age • elective delivery • Congenital Diaphragmatic Hernia Study Group

Abbreviations: CDH—congenital diaphragmatic hernia • ECMO—extracorporeal membrane oxygenation • OR—odds ratio • CI—confidence interval

Accepted Apr 29, 2008.


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