Charakteristika und Outcomedaten von Neugeborenen mit pränatal nicht diagnostizierter angeborener Zwerchfellhernie

 

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Zusammenfassung

Einleitung Die angeborene Zwerchfellhernie (CDH) gehört mit einer Mortalität von 20–35% zu den schwerwiegendsten neonatalen Fehlbildungen. Aktuell liegt die Rate der pränatal erkannten CDH’s bei 60–80%. Untersucht wurden Charakteristika und Outcomedaten von Kindern mit pränatal nicht erkannter CDH.

Methodik Eingeschlossen wurden postnatal diagnostizierte CDH-Neugeborene, die zwischen 2012 und 2021 am Universitätsklinikum Bonn behandelt wurden. Verglichen wurden Behandlungs- und Outcomedaten in Abhängigkeit zur Art der Entbindungsklinik, sowie gemäß der Apgar-Werte. Ebenso erfolgte der Vergleich von Behandlungs- und Outcomedaten zwischen pränatal und postnatal diagnostizierter CDH.

Ergebnisse Von 244 CDH-Neugeborenen wurden 22 eingeschlossen. Der Vergleich bei Geburt in einer Einrichtung mit und ohne pädiatrische Versorgung ergab für Mortalität: 9% vs. 27%, p=0,478; ECMO-Rate: 9% vs. 36%, p=0,300; Alter bei Diagnosestellung: 84 vs. 129 Min, p=0,049; Zeit zwischen Intubation und Diagnosestellung: 20 vs. 86 Min, p=0,019. Neugeborenen in der zweiten Gruppe zeigten signifikant schlechtere Werter für pH und pCO2. Weiterhin zeigte sich eine tendenziell höhere Mortalität und ECMO-Rate bei Kindern mit einem Apgar-Wert<7 vs.≥7. Kindern mit postnataler Diagnose hatten signifikant häufiger eine moderate oder schwere PH, sowie tendenziell häufiger eine kardialer Dysfunktion als pränatal Diagnostizierte.

Diskussion In unserer Kohorte wurde ca. jedes 10. Neugeborene mit CDH postnatal diagnostiziert. Die Geburt in einer Einrichtung ohne pädiatrische Versorgung ist mit einer späteren Diagnosestellung assoziiert, was eine Hyperkapnie bzw. Azidose mit nachfolgend schwererer pulmonaler Hypertonie begünstigen kann.

Abstract

Introduction Congenital diaphragmatic hernia (CDH) is one of the most severe neonatal malformations with a mortality of 20–35%. Currently, the rate of prenatally recognized CDHs is 60–80%. This study investigated the characteristics and outcome data of children with prenatally unrecognized CDH.

Methods Postnatally diagnosed CDH newborns treated at the University Hospital Bonn between 2012 and 2021 were included. Treatment and outcome data were compared according to type of maternity hospital, Apgar values, and between prenatally and postnatally diagnosed CDH.

Results Of 244 CDH newborns, 22 were included. Comparison for birth in a facility with vs. without pediatric care showed for mortality: 9% vs. 27%, p=0.478; ECMO rate: 9% vs. 36%, p=0.300; age at diagnosis: 84 vs. 129 min, p=0.049; time between intubation and diagnosis: 20 vs. 86 min, p=0.019. Newborns in the second group showed significantly worse values for pH and pCO2. Furthermore, there was a tendency for higher mortality and ECMO rates in children with an Apgar score<7 vs.≥7. Children diagnosed postnatally were significantly more likely to have moderate or severe PH and tended to have cardiac dysfunction more often than those diagnosed prenatally.

Discussion In our cohort, ca. one in 10 newborns received a postnatal CDH diagnosis. Birth in a facility without pediatric care is associated with later diagnosis, which may favor hypercapnia/acidosis and more severe pulm. hypertension

Publication History

Received: 14 March 2023

Accepted after revision: 17 October 2023

Article published online:
15 December 2023

© 2023. Thieme. All rights reserved.

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