Sex-Specific Differences in Congenital Diaphragmatic Hernia Mortality - 22/08/23
Doi : 10.1016/j.jpeds.2023.113481
Shelby R. Sferra, MD, MPH 1, Matthew Guo, BA 1, Andres J. Gonzalez Salazar, MD 1, Annalise B. Penikis, MD 1, Abigail J. Engwall-Gill, MD 1, Ashley Ebanks, APRN 2, Matthew T. Harting, MD, MS 2, Joseph M. Collaco, MD, PhD 3, Shaun M. Kunisaki, MD, MSc 1, ⁎ 
for the
for the
CDH Study Group
1 Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
2 Department of Pediatric Surgery, University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX
3 Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
∗Reprint requests: Shaun M. Kunisaki, MD, MSc, Professor of Surgery, Johns Hopkins Children's Center, 1800 Orleans St, Suite 7353, Baltimore, MD 21287Professor of SurgeryJohns Hopkins Children's Center1800 Orleans StSuite 7353BaltimoreMD21287
Abstract |
Objective |
To compare disease severity and mortality differences between female and male patients with congenital diaphragmatic hernia (CDH).
Study design |
We queried the CDH Study Group (CDHSG) database for CDH neonates managed between 2007 and 2018. Female and males were compared in statistical analyses using t tests, χ² tests, and Cox regression, as appropriate (P ≤ .05).
Results |
There were 7288 CDH patients, of which 3048 (41.8%) were female. Females weighed less on average at birth than males (2.84 kg vs 2.97 kg, P < .001) despite comparable gestational age. Females had similar rates of extracorporeal life support (ECLS) utilization (27.8% vs 27.3%, P = .65). Although both cohorts had equivalent defect size and rates of patch repair, female patients had increased rates of intrathoracic liver herniation (49.2% vs 45.9%, P = .01) and pulmonary hypertension (PH) (86.6% vs 81.1%, P < .001). Females had lower survival rates at 30-days (77.3% vs 80.1%, P = .003) and overall lower survival to discharge (70.2% vs 74.2%, P < .001). Subgroup analysis revealed that increased mortality was significant among those who underwent repair but were never supported on ECLS (P = .005). On Cox regression analysis, female sex was independently associated with mortality (adjusted hazard ratio 1.32, P = .02).
Conclusion |
After controlling for the established prenatal and postnatal predictors of mortality, female sex remains independently associated with a higher risk of mortality in CDH. Further study into the underlying causes for sex-specific disparities in CDH outcomes is warranted.
Le texte complet de cet article est disponible en PDF.Keywords : congenital diaphragmatic hernia, mortality, disparities
Abbreviations : CDH, CDHSG, CI, ECLS, HR, O/E LHR, PH
Plan
© 2023
Elsevier Inc. Tous droits réservés.
Vol 259
Article 113481- août 2023 Retour au numéro
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