Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study

Kazunori Masahata, Noriaki Usui, Kouji Nagata, Keita Terui, Masahiro Hayakawa, Shoichiro Amari, Kouji Masumoto, Tadaharu Okazaki, Noboru Inamura, Naoto Urushihara, Katsuaki Toyoshima, Keiichi Uchida, Taizo Furukawa, Manabu Okawada, Akiko Yokoi, Hiroomi Okuyama, Tomoaki Taguchi

Research output: Contribution to journalArticle

Abstract

Purpose: This study aimed to elucidate the clinical characteristics of neonates with congenital diaphragmatic hernia (CDH) associated with pneumothorax and evaluate the risk factors for the development of pneumothorax. Methods: A retrospective cohort study was conducted in the 15 institutions participating in the Japanese CDH Study Group. A total of 495 neonates with isolated CDH who were born between 2011 and 2018 were analyzed in this study. Results: Among the 495 neonates with isolated CDH, 52 (10.5%) developed pneumothorax. Eighteen (34.6%) patients developed pneumothorax before surgery, while 34 (65.4%) developed pneumothorax after surgery. The log-rank test showed that the cumulative survival rate was significantly lower in patients with pneumothorax than in those without pneumothorax. Univariate analysis revealed significant differences between patients with pneumothorax and those without pneumothorax with regard to the best oxygenation index within 24 h after birth, mean airway pressure (MAP) higher than 16 cmH2O, diaphragmatic defect size, and need for patch closure. Multiple logistic regression analysis indicated that only the MAP was associated with an increased risk of pneumothorax. Conclusions: The cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients.

Original languageEnglish
Pages (from-to)669-677
Number of pages9
JournalPediatric surgery international
Volume36
Issue number6
DOIs
Publication statusPublished - Jun 1 2020

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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    Masahata, K., Usui, N., Nagata, K., Terui, K., Hayakawa, M., Amari, S., Masumoto, K., Okazaki, T., Inamura, N., Urushihara, N., Toyoshima, K., Uchida, K., Furukawa, T., Okawada, M., Yokoi, A., Okuyama, H., & Taguchi, T. (2020). Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study. Pediatric surgery international, 36(6), 669-677. https://doi.org/10.1007/s00383-020-04659-3