Appropriate timing of surgery for neonates with congenital diaphragmatic hernia: early or delayed repair?

Purpose: This study was aimed to evaluate the influence of timing of surgery on patient outcomes, and to clarify appropriate timing of surgery in neonates with congenital diaphragmatic hernia (CDH). Methods: A total of 477 neonates with isolated CDH were included. Patients were classified into two groups by timing of surgery: early repair (ER) (≤48 h) and delayed repair (DR) (>48 h). The primary outcome was 90-day survival, with treatment duration (ventilation, oxygen, and hospitalization) being a secondary outcome. To adjust for disease severity, patients were stratified into three severities by Apgar score 1 min (“mild” 8–10, “moderate” 4–7, and “severe” 0–3), and outcomes were compared between ER and DR within each severity. Results: Although 90-day survival was significantly different among the three severities (“mild” 97%, “moderate” 89%, and “severe” 76%, p = 0.002), there were no differences in 90-day survival between DR and ER within each severity. In “mild”, there were no differences in treatment duration between ER and DR. In “moderate”, treatment duration was shorter in ER than DR (ventilation 11 vs. 16 days, oxygen 15 vs. 20 days, and hospitalization 34 vs. 48 days). In “severe”, treatment duration was shorter in ER than DR, while the best OI was higher in DR than ER. Conclusions: Timing of CDH repair seems to have no influence on 90-day survival regardless of disease severity. Patients with moderate severity may benefit from the early repair by reducing treatment duration.