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

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. 1.

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

    Article  Google Scholar 

  2. 2.

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

    Article  Google Scholar 

  3. 3.

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

    Article  Google Scholar 

  4. 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. 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.

    CAS  Article  Google Scholar 

  6. 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. 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.

    CAS  Article  Google Scholar 

  8. 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.

    CAS  Article  Google Scholar 

  9. 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. 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. 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. 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.

    CAS  Article  Google Scholar 

  13. 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.

    CAS  Article  Google Scholar 

  14. 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. 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.

    CAS  Article  Google Scholar 

  16. 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.

    CAS  Article  Google Scholar 

  17. 17.

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

    Article  Google Scholar 

  18. 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. 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. 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. 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. 22.

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

    CAS  Article  Google Scholar 

  23. 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. 24.

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

    Article  Google Scholar 

  25. 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.

    CAS  Article  Google Scholar 

  26. 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

    CAS  Article  Google Scholar 

  27. 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. 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. 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. 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. 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.

    CAS  Article  Google Scholar 

  32. 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.

    CAS  Article  Google Scholar 

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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.

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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.

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Correspondence to Makiko Fuyuki.

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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 (2020). https://doi.org/10.1038/s41372-020-00833-6

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