Risk Factors for the Recurrence of the Congenital Diaphragmatic Hernia—Report from the Long-Term Follow-Up Study of Japanese CDH Study Group

Kouji Nagata; Noriaki Usui; Keita Terui; Hajime Takayasu; Keiji Goishi; Masahiro Hayakawa; Yuko Tazuke; Akiko Yokoi; Hiroomi Okuyama; Tomoaki Taguchi

doi:10.1055/s-0034-1395486

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2015; 25(01): 9-14
DOI: 10.1055/s-0034-1395486

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Risk Factors for the Recurrence of the Congenital Diaphragmatic Hernia—Report from the Long-Term Follow-Up Study of Japanese CDH Study Group

Kouji Nagata

¹Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan

,

Noriaki Usui

²Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

,

Keita Terui

³Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

,

Hajime Takayasu

⁴Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

,

Keiji Goishi

⁵Division of Neonatology, Department of Maternal and Perinatal Medicine, National Center for Child Health and Development, Tokyo, Japan

,

Masahiro Hayakawa

⁶Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

,

Yuko Tazuke

⁷Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

,

Akiko Yokoi

⁸Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan

,

Hiroomi Okuyama

⁹Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan

,

Tomoaki Taguchi

¹Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan

› Author Affiliations

Abstract

Aim of the Study Few follow-up studies focused on the recurrence regarding the postoperative course of congenital diaphragmatic hernia (CDH) survivors. The aim of this study was to report on risk factor for CDH patients who had the recurrence during the follow-up.

Materials and Methods A multicenter retrospective survey was conducted on neonates diagnosed to have CDH between January 2006 and December 2010. Follow-up survey was conducted between September 2013 and October 2013 (ethical approval: No. 25–222). Nine institutions agreed to participate in this survey. Out of 228, 182 (79.8%) patients were alive and 180 patients were included in this study. Two patients were excluded because the defect had not repaired at the primary operation. The patients were divided into the recurrence group (n = 21) and the nonrecurrence group (n = 159). Postnatal and postoperative variables were compared between these two groups. Baseline variables which showed significance in univariate analysis were entered into multiple logistic regression analysis for analyzing the recurrence. A value of p < 0.05 was considered to be statistically significant by using the JMP software program (version 9; SAS Institute, Inc, Cary, North Carolina, United States).

Main Results Out of 180, 21 (11.7%) CDH neonates had the recurrence during the course of the follow-up. Five (2.8%) patients had the recurrence before primary discharge and 16 (8.9%) patients had the recurrence after discharge. Univariate analysis showed that liver herniation (crude odds ratio [OR], 7.4; 95% confidence interval [CI], 2.73–23.68), defect size C and D, proposed by the CDH Study Group (crude OR, 7.09; 95% CI, 2.73–19.99) and patch repair (crude OR, 5.00; 95% CI, 1.91–14.70) were risk factors. Multivariate logistic regression analysis showed liver herniation (adjusted OR, 3.96; 95% CI, 1.01–16.92) was the risk factor for the recurrence.

Conclusion A wide spectrum of the disease severity and the rarity of the disease mask the risk of the recurrence for CDH patients. This study showed the only factor to predict the recurrence was the liver herniation. These data will be helpful for providing information for the long-term follow-up of the CDH patients.

Keywords

congenital diaphragmatic hernia - long-term complication - recurrence

Full Text

References

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