Objective: The aim of this study was to analyze if the healthcare organization of perinatal care and availability of referral neonatal intensive care units (NICU) impacted congenital diaphragmatic hernia (CDH) neonatal mortality in the period 2004-2020. This study analyzed the spatial distribution of neonatal deaths of live births with CDH in São Paulo State, Brazil, and its association with NICU beds' availability.
Methods: Population-based study of all live births in São Paulo State from mothers residing in the same State, from 2004 to 2020. CDH definition was based on WHO-ICD-10 codes; CDH-associated neonatal death was defined as death up to 27 days after birth of infants with CDH. The distribution of CDH-associated neonatal mortality (per 10,000 live births) and NICU beds' availability (≥1 or not available) was mapped, and their association was evaluated by the Mann-Whitney test.
Results: Among 10,246,686 live births, there were 1378 CDH-associated neonatal deaths across 124/645 (19.2%) municipalities of the State. The median CDH-associated neonatal mortality rate in municipalities with NICU beds was 1.22 (95%CI 0.99-1.51), similar to that found in municipalities with no NICU beds (1.40; 95%CI 1.15-1.67; p=0.224).
Conclusions: CDH-associated neonatal deaths were spread throughout São Paulo State with no difference in CDH-associated neonatal mortality rates between municipalities with and without NICU beds available. These findings suggest the necessity of implementing regionalization strategies for CDH perinatal care in the State.
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| http://dx.doi.org/10.1590/1984-0462/2025/43/2024138 | DOI Listing |
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Neonatal mortality of live births with congenital diaphragmatic hernia in São Paulo State, Brazil: Failure of care?
Rev Paul Pediatr
January 2025
Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.
Objective: The aim of this study was to analyze if the healthcare organization of perinatal care and availability of referral neonatal intensive care units (NICU) impacted congenital diaphragmatic hernia (CDH) neonatal mortality in the period 2004-2020. This study analyzed the spatial distribution of neonatal deaths of live births with CDH in São Paulo State, Brazil, and its association with NICU beds' availability.
Methods: Population-based study of all live births in São Paulo State from mothers residing in the same State, from 2004 to 2020.
Association between Time with Open Ductus Arteriosus and Outcomes in Congenital Diaphragmatic Hernia.
Neonatology
November 2024
Department of Neonatal-Perinatal Medicine, Baylor College of Medicine, Houston, Texas, USA.
Introduction: While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH.
Methods: A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND.
Evaluation of Hyponatremia in Infants on Vasopressin Therapy.
J Pediatr Pharmacol Ther
August 2024
Division of Pharmacy (BH, TH), Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Article Synopsis
- The study investigates the effects of vasopressin on sodium levels in infants, particularly those with congenital diaphragmatic hernia (CDH), known for its potential to manage hypotension and pulmonary hypertension.
- Researchers reviewed patient data to identify how often hyponatremia (low sodium) occurred during vasopressin treatment, comparing outcomes between CDH patients and those without.
- Results indicated that while both groups experienced significant drops in sodium levels, CDH patients had higher risks of severe hyponatremia and required more vasopressin, highlighting the need for careful sodium management in this population.
Fetal biophysical predictors of pulmonary hypertension severity, management, and treatment in infants born with congenital diaphragmatic hernia.
Am J Surg
October 2024
University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, USA; University of North Carolina, Department of Surgery, Division of Pediatric Surgery, Chapel Hill, NC, USA. Electronic address:
Background: Pulmonary hypertension (PHTN) causes significant morbidity and mortality in patients with congenital diaphragmatic hernia (CDH). Currently, there is no routinely obtained prenatal prognostic marker to reliably predict postnatal CDH-associated PHTN severity.
Methods: The CDH Study Group (CDHSG) registry was queried for infants born from 2015 to 2021 with a graded (1-4) PHTN diagnosis.
Congenital diaphragmatic hernia-associated pulmonary hypertension.
Semin Pediatr Surg
August 2024
Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA. Electronic address:
Congenital diaphragmatic hernia (CDH) is characterized by a developmental insult which compromises cardiopulmonary embryology and results in a diaphragmatic defect, allowing abdominal organs to herniate into the hemithorax. Among the significant pathophysiologic components of this condition is pulmonary hypertension (PH), alongside pulmonary hypoplasia and cardiac dysfunction. Fetal pulmonary vascular development coincides with lung development, with the pulmonary vasculature evolving alongside lung maturation.
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