Objective

To determine in-hospital morbidities for neonates with right-sided congenital diaphragmatic hernia (R-CDH) compared with those with left-sided defects (L-CDH) and to examine the differential effect of laterality and defect size on morbidities.

Study design

This retrospective, multicenter, cohort study from the international Congenital Diaphragmatic Hernia Study Group registry collected data from neonates with CDH surviving until hospital discharge from 90 neonatal intensive care units between January 1, 2007, and July 31, 2020. Major pulmonary, cardiac, neurologic, and gastrointestinal morbidities were compared between neonates with L-CDH and R-CDH, adjusted for prenatal and postnatal factors using logistic regression.

Results

Of 4123 survivors with CDH, those with R-CDH (n = 598 [15%]) compared with those with L-CDH (n = 3525 [85%]) had an increased odds of pulmonary (1.7; 95% CI, 1.4-2.2, P < .0001), cardiac (1.4; 95% CI, 1.1-1.8; P = .01), gastrointestinal (1.3; 95% CI, 1.1-1.6; P = .01), and multiple (1.6; 95% CI, 1.2-2.0; P < .001) in-hospital morbidities, with a greater likelihood of morbidity with increasing defect size. There was no difference in neurologic morbidities between the groups.

Conclusions

Neonates with R-CDH and a larger defect size are at an increased risk for in-hospital morbidities. Counseling and clinical strategies should incorporate knowledge of these risks, and approach to neonatal R-CDH should be distinct from current practices targeted to L-CDH.

中文翻译：

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先天性膈疝新生儿的院内并发症：缺损大小和偏侧的影响

客观的

确定右侧先天性膈疝 (R-CDH) 新生儿与左侧缺损 (L-CDH) 新生儿的住院发病率，并检查偏侧性和缺损大小对发病率的不同影响。

学习规划

这项来自国际先天性膈疝研究组登记处的回顾性、多中心、队列研究收集了 2007 年 1 月 1 日至 2020 年 7 月 31 日期间 90 个新生儿重症监护病房的 CDH 新生儿存活至出院的数据。主要的肺、心脏、神经系统, 并比较了 L-CDH 和 R-CDH 新生儿的胃肠道发病率，并使用逻辑回归调整了产前和产后因素。

结果

在 4123 名 CDH 幸存者中，R-CDH 患者 (n = 598 [15%]) 与 L-CDH 患者 (n = 3525 [85%]) 的肺部发病几率增加 (1.7; 95% CI, 1.4 -2.2, P  < .0001)、心脏 (1.4; 95% CI, 1.1-1.8; P  = .01)、胃肠道 (1.3; 95% CI, 1.1-1.6; P  = .01) 和多发性 (1.6; 95% CI，1.2-2.0；P  < .001) 院内发病率，随着缺损尺寸的增加，发病率增加。两组之间的神经系统发病率没有差异。

结论

患有 R-CDH 且缺损较大的新生儿在院内发病的风险增加。咨询和临床策略应纳入对这些风险的了解，并且新生儿 R-CDH 的方法应与当前针对 L-CDH 的做法不同。