Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia

PurposePulmonary support (PS) on day-of-life-30 (DOL-30) has been shown to be the strongest predictor of subsequent morbidity and in-patient mortality in congenital diaphragmatic hernia (CDH). We hypothesized that PS on DOL-30 can also predict long-term outcomes in CDH survivors.MethodsWe analyzed records of 201 CDH survivors followed by a single multidisciplinary clinic (1995–2010). Follow-up was 83 and 70% at 1 and 5 years respectively. PS was defined as: (1) invasive support (n = 44), (2) noninvasive support (n = 54), or (3) room air (n = 103). Logistic regression was used to estimate the adjusted association of PS on DOL-30 with outcomes at 1 and 5-years.ResultsUse of PS on DOL-30 was significantly associated with pulmonary and developmental morbidities at 1 and 5-years. Even after adjusting for defect-size and presence of ventilation/perfusion mismatch, greater PS on DOL-30 was associated with a significantly increased odds of requiring supplemental oxygen and developmental referral at 1-year, and asthma and developmental referral at 5-years.ConclusionCDH survivors continue to have significant long-term pulmonary and developmental morbidities. PS on DOL-30 is a strong independent predictor of morbidity at 1 and 5-years and may be used as a simple prognostic tool to identify high-risk infants.