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Prognosis of conventional vs. high-frequency ventilation for congenital diaphragmatic hernia: a retrospective cohort study

Journal of Perinatology volume 41, pages 814–823 (2021)Cite this article

Subjects

Abstract

Objective

To determine the appropriate initial ventilatory mode for neonatal congenital diaphragmatic hernia (CDH) by comparing patient prognosis following conventional mechanical ventilation (CMV) versus high-frequency oscillatory ventilation (HFO).

Study design

This multicenter retrospective cohort study was performed at 15 participating hospitals in Japan between 2011 and 2016. The 328 eligible CDH infants were classified into CMV (n = 78) and HFO groups (n = 250) to compare mortality and incidence of bronchopulmonary dysplasia (BPD). Propensity score matching was applied to reduce confounding by indication.

Result

While crude mortality was significantly higher in the HFO than the CMV group, adjusted odds ratio (OR) did not show significant difference in mortality between groups (OR of HFO group: 0.98, 95% confidence interval (CI): 0.57–1.67). Adjusted OR of BPD incidence showed no significant difference between groups (OR of HFO group: 1.66, 95%CI: 0.50–5.49).

Conclusion

Initial ventilatory mode in CDH patients, whether CMV or HFO, does not affect prognosis.

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References

  1. Leeuwen L, Fitzgerald DA. Congenital diaphragmatic hernia. J Paediatr Child Health. 2014;50:667–73.

    Article  Google Scholar 

  2. Tovar JA. Congenital diaphragmatic hernia. Orphanet J Rare Dis. 2012;7:1.

    Article  Google Scholar 

  3. Harting MT. Congenital diaphragmatic hernia-associated pulmonary hypertension. Semin Pediatr Surg. 2017;26:147–53.

    Article  Google Scholar 

  4. Wung JT, James LS, Kilchevsky E, James E. Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation. Pediatrics. 1985;76:488–94.

    CAS  PubMed  Google Scholar 

  5. Wung JT, Sahni R, Moffitt ST, Lipsitz E, Stolar CJ. Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg. 1995;30:406–9.

    Article  CAS  Google Scholar 

  6. Chiu PP, Sauer C, Mihailovic A, Adatia I, Bohn D, Coates AL, et al. The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in long-term morbidity? J Pediatr Surg. 2006;41:888–92.

    Article  Google Scholar 

  7. Desfrere L, Jarreau PH, Dommergues M, Brunhes A, Hubert P, Nihoul-Fekete C, et al. Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns. Intensive Care Med. 2000;26:934–41.

    Article  CAS  Google Scholar 

  8. Cacciari A, Ruggeri G, Mordenti M, Ceccarelli PL, Baccarini E, Pigna A, et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia. Eur J Pediatr Surg. 2001;11:3–7.

    Article  CAS  Google Scholar 

  9. Ng GY, Derry C, Marston L, Choudhury M, Holmes K, Calvert SA. Reduction in ventilator-induced lung injury improves outcome in congenital diaphragmatic hernia? Pediatr Surg Int. 2008;24:145–50.

    Article  Google Scholar 

  10. Snoek KG, Capolupo I, van Rosmalen J, Hout Lde J, Vijfhuize S, Greenough A, et al. Conventional mechanical ventilation versus high-frequency oscillatory ventilation for congenital diaphragmatic hernia: A randomized clinical trial (the VICI-trial). Ann Surg. 2016;263:867–74.

    Article  Google Scholar 

  11. Nagata K, Usui N, Kanamori Y, Takahashi S, Hayakawa M, Okuyama H, et al. The current profile and outcome of congenital diaphragmatic hernia: a nationwide survey in Japan. J Pediatr Surg. 2013;48:738–44.

    Article  Google Scholar 

  12. Hatcher D, Watanabe H, Ashbury T, Vincent S, Fisher J, Froese A. Mechanical performance of clinically available, neonatal, high-frequency, oscillatory-type ventilators. Crit Care Med. 1998;26:1081–8.

    Article  CAS  Google Scholar 

  13. Pillow JJ, Wilkinson MH, Neil HL, Ramsden CA. In vitro performance characteristics of high-frequency oscillatory ventilators. Am J Respir Crit Care Med. 2001;164:1019–24.

    Article  CAS  Google Scholar 

  14. van den Hout L, Tibboel D, Vijfhuize S, te Beest H, Hop W, Reiss I, CDH-EURO Consortium. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial. BMC Pediatr. 2011;11:98.

    Article  Google Scholar 

  15. Kitano Y, Okuyama H, Saito M, Usui N, Morikawa N, Masumoto K, et al. Re-evaluation of stomach position as a simple prognostic factor in fetal left congenital diaphragmatic hernia: a multicenter survey in Japan. Ultrasound Obstet Gynecol. 2011;37:277–82.

    Article  CAS  Google Scholar 

  16. Terui K, Nagata K, Kanamori Y, Takahashi S, Hayakawa M, Okuyama H, et al. Risk stratification for congenital diaphragmatic hernia by factors within 24 h after birth. J Perinatol. 2017;37:805–8.

    Article  CAS  Google Scholar 

  17. Mohseni-Bod H, Bohn D. Pulmonary hypertension in congenital diaphragmatic hernia. Semin Pediatr Surg. 2007;16:126–33.

    Article  Google Scholar 

  18. Okazaki T, Kohno S, Hasegawa S, Urushihara N, Yoshida A, Kawano S, et al. Congenital diaphragmatic hernia: efficacy of ultrasound examination in its management. Pediatr Surg Int. 2003;19:176–9.

    Article  Google Scholar 

  19. Alfaraj MA, Shah PS, Bohn D, Pantazi S, O’Brien K, Chiu PP, et al. Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol. 2011;205:43.e1–e8.

    Article  Google Scholar 

  20. Benachi A, Cordier AG, Cannie M, Jani J. Advances in prenatal diagnosis of congenital diaphragmatic hernia. Semin Fetal Neonatal Med. 2014;19:331–7.

    Article  Google Scholar 

  21. Chandrasekharan PK, Rawat M, Madappa R, Rothstein DH, Lakshminrusimha S. Congenital diaphragmatic hernia - a review. Matern Health Neonatol Perinatol. 2017;3:6.

    Article  Google Scholar 

  22. Platt MJ. Outcomes in preterm infants. Public Health. 2014;128:399–403.

    Article  CAS  Google Scholar 

  23. Morini F, Capolupo I, van Weteringen W, Reiss I. Ventilation modalities in infants with congenital diaphragmatic hernia. Semin Pediatr Surg. 2017;26:159–65.

    Article  Google Scholar 

  24. Ruzic A. Contemporary ventilatory strategies for surgical patients. Semin Pediatr Surg. 2019;28:18–25.

    Article  Google Scholar 

  25. Miguet D, Claris O, Lapillonne A, Bakr A, Chappuis JP, Salle BL. Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med. 1994;22:S77–S82.

    Article  CAS  Google Scholar 

  26. Reyes C, Chang LK, Waffarn F, Mir H, Warden MJ, Sills J. Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization. J Pediatr Surg. 1998;33:1010–4. discussion 4-6

    Article  CAS  Google Scholar 

  27. Migliazza L, Bellan C, Alberti D, Auriemma A, Burgio G, Locatelli G, et al. Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg. 2007;42:1526–32.

    Article  Google Scholar 

  28. Snoek KG, Reiss IK, Greenough A, Capolulo I, Urlesberger B, Wessel L, et al. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatology. 2016;110:66–74.

    Article  Google Scholar 

  29. Cauley RP, Potanos K, Fullington N, Bairdain S, Sheils CA, Finkelstein JA, et al. Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia. J Pediatr Surg. 2015;50:849–55.

    Article  Google Scholar 

  30. Cauley RP, Stoffan A, Potanos K, Fullington N, Graham DA, Finkelstein JA, et al. Pulmonary support on day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia. J Pediatr Surg. 2013;48:1183–9.

    Article  Google Scholar 

  31. Peetsold MG, Heij HA, Kneepkens CM, Nagelkerke AF, Huisman J, Gemke RJ. The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity. Pediatr Surg Int. 2009;25:1–17.

    Article  CAS  Google Scholar 

  32. Yagi M, Kohno M, Asagiri K, Ikeda T, Okada T, Kanada S, et al. Twenty-year trends in neonatal surgery based on a nationwide Japanese surveillance program. Pediatr Surg Int. 2015;31:955–62.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank all the members of the Japanese CDH Study Group and all the participant institutes in this study.

The Japanese Congenital Diaphragmatic Hernia Study Group

Hiroomi Okuyama17, Noriaki Usui3, Tomoaki Taguchi4, Masahiro Hayakawa5, Kouji Masumoto6, Yutaka Kanamori7, Shoichiro Amari8, Naoto Urushihara9, Noboru Inamura10, Akiko Yokoi11, Tadaharu Okazaki12,13, Katsuaki Toyoshima14, Taizou Furukawa15, Keita Terui16, Satoko Ohfuji2, Yuko Tazuke17, Keiichi Uchida18, Genshiro Esumi19, Jyunya Oomura20, Manabu Okawada12, Kohei Sakai15, Takuya Kondo21, Toshiharu Matsuura21, Kouji Motokura22, Motoyoshi Kawataki14, Kaoru Katsumata14, Mikihiro Inoue23, Kouji Nagata24, Miharu Ito25, Ryousuke Miura5, Kazuhito Ueda5, Yoshiaki Sato5, Akiko Saitou5, Yukako Muramatsu5, Shinobu Sekimoto5, Yasuhisa Ikuta8, Yuichi Takama17, Ryuta Saka17, Ayako Matsuura17, Yasuji Kitabatake26, Hidetoshi Taniguchi27, Muneyuki Takeuchi28, Atsushi Kawamura28, Narutaka Mochizuki29, Makiko Fuyuki1,2, Masaya Yamoto9, Koji Fukumoto9, Yui Ueda30, Hajime Takayasu6, Yasuhisa Urita6, Sasagu Kimura31

Funding

This work was supported by the Japan Agency for Medical Research and Development under Grant Number JP19ek0109264s1303.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan

    Makiko Fuyuki & Makiko Fuyuki

  2. Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan

    Makiko Fuyuki, Satoko Ohfuji, Satoko Ohfuji & Makiko Fuyuki

  3. Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Izumi, Japan

    Noriaki Usui & Noriaki Usui

  4. Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Tomoaki Taguchi & Tomoaki Taguchi

  5. Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Masahiro Hayakawa, Masahiro Hayakawa, Ryousuke Miura, Kazuhito Ueda, Yoshiaki Sato, Akiko Saitou, Yukako Muramatsu & Shinobu Sekimoto

  6. Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kouji Masumoto, Kouji Masumoto, Hajime Takayasu & Yasuhisa Urita

  7. Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan

    Yutaka Kanamori & Yutaka Kanamori

  8. Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

    Shoichiro Amari, Shoichiro Amari & Yasuhisa Ikuta

  9. Department of Pediatric Surgery, Shizuoka Children’s Hospital, Shizuoka, Japan

    Masaya Yamoto, Naoto Urushihara, Naoto Urushihara, Masaya Yamoto & Koji Fukumoto

  10. Department of Pediatrics, Kinki University, Faculty of Medicine, Osaka-Sayama, Japan

    Noboru Inamura & Noboru Inamura

  11. Department of Pediatric Surgery, Kobe Children’s Hospital, Kobe, Japan

    Akiko Yokoi & Akiko Yokoi

  12. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Manabu Okawada, Tadaharu Okazaki & Tadaharu Okazaki

  13. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan

    Tadaharu Okazaki & Tadaharu Okazaki

  14. Department of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan

    Katsuaki Toyoshima, Katsuaki Toyoshima, Motoyoshi Kawataki & Kaoru Katsumata

  15. Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Taizou Furukawa, Taizou Furukawa & Kohei Sakai

  16. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Keita Terui & Keita Terui

  17. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Yuko Tazuke, Hiroomi Okuyama, Hiroomi Okuyama, Yuko Tazuke, Manabu Okawada, Yuichi Takama, Ryuta Saka & Ayako Matsuura

  18. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan

    Keiichi Uchida & Keiichi Uchida

  19. Department of Pediatric Surgery, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan

    Genshiro Esumi

  20. Department of Neonatology and Pediatrics, Japan Community Health care Organization Kyusu Hospiral, Fukuoka, Japan

    Jyunya Oomura

  21. Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan

    Takuya Kondo & Toshiharu Matsuura

  22. Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan

    Kouji Motokura

  23. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan

    Mikihiro Inoue

  24. Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan

    Kouji Nagata

  25. Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Miharu Ito

  26. Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Yasuji Kitabatake

  27. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Hidetoshi Taniguchi

  28. Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, Izumi, Japan

    Muneyuki Takeuchi & Atsushi Kawamura

  29. Department of Neonatal Medicine, Osaka Women’s and Children’s Hospital, Izumi, Japan

    Narutaka Mochizuki

  30. Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Yui Ueda

  31. Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan

    Sasagu Kimura

Authors
  1. Makiko Fuyuki
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  2. Noriaki Usui
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  3. Tomoaki Taguchi
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  4. Masahiro Hayakawa
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  5. Kouji Masumoto
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  6. Yutaka Kanamori
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  7. Shoichiro Amari
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  8. Masaya Yamoto
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  9. Naoto Urushihara
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  10. Noboru Inamura
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  11. Akiko Yokoi
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  12. Manabu Okawada
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  13. Tadaharu Okazaki
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  14. Katsuaki Toyoshima
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  15. Taizou Furukawa
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  16. Keita Terui
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  18. Yuko Tazuke
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  19. Keiichi Uchida
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  20. Hiroomi Okuyama
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Consortia

for the Japanese Congenital Diaphragmatic Hernia Study Group

  • Hiroomi Okuyama
  • , Noriaki Usui
  • , Tomoaki Taguchi
  • , Masahiro Hayakawa
  • , Kouji Masumoto
  • , Yutaka Kanamori
  • , Shoichiro Amari
  • , Naoto Urushihara
  • , Noboru Inamura
  • , Akiko Yokoi
  • , Tadaharu Okazaki
  • , Katsuaki Toyoshima
  • , Taizou Furukawa
  • , Keita Terui
  • , Satoko Ohfuji
  • , Yuko Tazuke
  • , Keiichi Uchida
  • , Genshiro Esumi
  • , Jyunya Oomura
  • , Manabu Okawada
  • , Kohei Sakai
  • , Takuya Kondo
  • , Toshiharu Matsuura
  • , Kouji Motokura
  • , Motoyoshi Kawataki
  • , Kaoru Katsumata
  • , Mikihiro Inoue
  • , Kouji Nagata
  • , Miharu Ito
  • , Ryousuke Miura
  • , Kazuhito Ueda
  • , Yoshiaki Sato
  • , Akiko Saitou
  • , Yukako Muramatsu
  • , Shinobu Sekimoto
  • , Yasuhisa Ikuta
  • , Yuichi Takama
  • , Ryuta Saka
  • , Ayako Matsuura
  • , Yasuji Kitabatake
  • , Hidetoshi Taniguchi
  • , Muneyuki Takeuchi
  • , Atsushi Kawamura
  • , Narutaka Mochizuki
  • , Makiko Fuyuki
  • , Masaya Yamoto
  • , Koji Fukumoto
  • , Yui Ueda
  • , Hajime Takayasu
  • , Yasuhisa Urita
  •  & Sasagu Kimura

Contributions

MF drafted and wrote the manuscript. MF and SO contributed to the statistical analysis. NUs, TT, MH, KM, YK, SA, MY, NUr, NI, AY, MO, TO, KTo, TF, KTe, YT, KU, and HO participated in the study design and helped to draft the manuscript. All authors contributed to the interpretation of the findings and read and approved the final manuscript.

Corresponding author

Correspondence to Makiko Fuyuki.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Japanese Congenital Diaphragmatic Hernia Study Group are listed below Acknowledgements.

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Fuyuki, M., Usui, N., Taguchi, T. et al. Prognosis of conventional vs. high-frequency ventilation for congenital diaphragmatic hernia: a retrospective cohort study. J Perinatol 41, 814–823 (2021). https://doi.org/10.1038/s41372-020-00833-6

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