Original ArticleOutcomes of Congenital Diaphragmatic Hernia in the Modern Era of Management
Section snippets
Methods
Subjects were recruited as part of the Diaphragmatic Hernia Research and Exploration, Advancing Molecular Science (DHREAMS) study (http://www.cdhgenetics.com). The DHREAMS study is a prospective cohort of neonates with a diaphragm defect identified at 1 of 7 collaborating medical centers. Columbia University began enrollment in January 2005, and recruitment at 6 other sites (Washington University Medical Center/St. Louis Children's Hospital, University of Pittsburgh, Cincinnati Children's
Results
A total of 220 of the 313 eligible cases born at participating centers during the study time period consented to enrollment in the DHREAMS study (Table I). The average gestational age was 37 weeks. White, non-Hispanic patients comprised 54.5% of the study population; 56.8 % were male; 84.1% of the diaphragmatic lesions were left sided; and 61.8% of the patients had an isolated CDH. Of the patients with other anomalies, congenital heart disease was the most common in 21.4% of the entire cohort.
Discussion
Recent advances in the post-natal care of children with CDH at specialized centers have improved survival and decreased the need for ECMO.3 However, with improved survival, many of the long-term morbidities of CDH have been exposed. The leading cause of morbidity and mortality in patients with CDH is severe hypoxic respiratory failure, resulting from pulmonary hypoplasia and abnormal pulmonary vascular development and vasoreactivity, leading to PH.3, 9, 10 Recent studies have correlated the
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Supported by the National Institute of Health (National Institute of Child Health and Development R-01 HD057036 - Identification of Novel Genes for Congenital Diaphragmatic Hernia) and Columbia University's Clinical and Translational Science Award (UL1 RR024156 from National Center for Advancing Translational Sciences-National Center for Research Resources/National Institutes of Health). The authors declare no conflicts of interest.
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Contributed equally.