Pulmonary support on Day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia

PurposeCongenital diaphragmatic hernia (CDH) is associated with significant in-hospital mortality, morbidity and length-of-stay (LOS). We hypothesized that the degree of pulmonary support on hospital day-30 may predict in-hospital mortality, LOS, and discharge oxygen needs and could be useful for risk prediction and counseling.Methods862 patients in the CDH Study Group registry with a LOS ≥ 30 days were analyzed (2007–2010). Pulmonary support was defined as (1) room-air (n = 320) (2) noninvasive supplementation (n = 244) (3) mechanical ventilation (n = 279) and (4) extracorporeal membrane oxygenation (ECMO, n = 19). Cox Proportional hazards and logistic regression models were used to determine the case-mix adjusted association of oxygen requirements on day-30 with mortality and oxygen requirements at discharge.ResultsOn multivariate analysis, use of ventilator (HR 5.1, p = .003) or ECMO (HR 19.6, p < .001) was a significant predictor of in-patient mortality. Need for non-invasive supplementation or ventilator on day-30 was associated with a respective 22-fold (p < .001) and 43-fold (p < .001) increased odds of oxygen use at discharge compared to those on room-air.ConclusionsPulmonary support on Day-30 is a strong predictor of length of stay, oxygen requirements at discharge and in-patient mortality and may be used as a simple prognostic indicator for family counseling, discharge planning, and identification of high-risk infants.