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Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia.
- Source :
-
Pediatrics [Pediatrics] 2003 Sep; Vol. 112 (3 Pt 1), pp. 532-5. - Publication Year :
- 2003
-
Abstract
- Objective: Reported survival in congenital diaphragmatic hernia (CDH) fails to allow for case selection bias. This study reports the incidence of CDH in a geographically defined population over 11 years and assesses the effect of new therapies (high-frequency oscillatory ventilation, extracorporeal membrane oxygenation, inhaled nitric oxide, and delayed surgery) on survival when case selection is avoided.<br />Methods: A retrospective review of cases from a regional case registry, the Northern Region Congenital Anomaly Survey, was conducted.<br />Results: A total of 185 cases were identified. Mortality was 62% and did not vary significantly during the study period. Mortality was unaffected by the introduction of new therapies. There was a significant inverse correlation between the rate of elective termination and survival of live borns. The presence of an additional anomaly increased mortality to 79%.<br />Conclusions: The mortality of CDH when complete case ascertainment is achieved is unaffected by new therapies. The survival rate is principally determined by the rate of antenatal termination and the incidence of associated anomalies. Reports of improved survival of CDH should be interpreted with caution, as variations in outcome are more likely to be explained by case selection artifact.
- Subjects :
- Abnormalities, Multiple diagnosis
Abnormalities, Multiple epidemiology
Abnormalities, Multiple mortality
Abnormalities, Multiple therapy
Cohort Studies
Fetal Death epidemiology
Hernia, Diaphragmatic epidemiology
Hernia, Diaphragmatic therapy
Humans
Incidence
Infant, Newborn
Infant, Newborn, Diseases diagnosis
Infant, Newborn, Diseases epidemiology
Infant, Newborn, Diseases mortality
Infant, Newborn, Diseases therapy
Neonatal Screening methods
Neonatal Screening trends
Prenatal Diagnosis statistics & numerical data
Prenatal Diagnosis trends
Retrospective Studies
Survival Analysis
Survival Rate
Hernia, Diaphragmatic mortality
Hernias, Diaphragmatic, Congenital
Infant Mortality trends
Subjects
Details
- Language :
- English
- ISSN :
- 1098-4275
- Volume :
- 112
- Issue :
- 3 Pt 1
- Database :
- MEDLINE
- Journal :
- Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 12949279
- Full Text :
- https://doi.org/10.1542/peds.112.3.532