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Background <p>Congenital diaphragmatic hernia (CDH) remains a life-threatening neonatal condition, particularly in resource-limited settings without access to extracorporeal membrane oxygenation (ECMO). Early identification of prognostic markers may improve risk stratification and clinical decision-making. This study evaluated the association of oxygenation index (OI), defect size, and perioperative characteristics with in-hospital mortality in surgically treated neonates with CDH at a national referral center in Ecuador.</p> Methods <p>We conducted an observational, cross-sectional study of 40 neonates who underwent surgical repair of CDH between January 2019 and January 2024. Demographic, clinical, perioperative, and postoperative variables were obtained from anonymized medical records. Associations between OI category (&lt; 40 vs. &gt; 40) and clinical characteristics were assessed using the chi-square test or Fisher exact test, as appropriate. Crude odds ratios were calculated for clinically relevant variables, and multivariable logistic regression was used to examine the association of OI and defect size with in-hospital mortality.</p> Results <p>Of the 40 neonates included, 31 (77.5%) had OI &lt; 40 and 9 (22.5%) had OI &gt; 40. Comorbidities were more frequent in the OI &gt; 40 group than in the OI &lt; 40 group (100% vs. 61.29%; <i>p</i> = 0.037). Defect size showed a borderline association with higher OI (<i>p</i> = 0.057), with C + D defects more common among neonates with OI &gt; 40. Surgical approach also differed according to OI category, with open repair more frequent in the OI &gt; 40 group (<i>p</i> = 0.044). Overall, in-hospital mortality was 35%. In the adjusted model, C + D defect size was associated with higher odds of mortality (odds ratio, 24.99; <i>p</i> = 0.033), whereas OI was not significantly associated with death.</p> Conclusion <p>In this cohort of surgically treated neonates with CDH, larger defect size was associated with greater respiratory severity and higher in-hospital mortality. OI reflected early clinical compromise but was not independently associated with mortality in the adjusted analysis. These findings support the clinical value of standardized defect classification as part of early risk assessment in resource-limited settings without ECMO.</p>

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Association of Diaphragmatic Defect Size with In-hospital Mortality in Surgically Treated Ecuadorian Neonates with Congenital Diaphragmatic Hernia

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Kim Calvas,
  • Fabricio González-Andrade

摘要

Background

Congenital diaphragmatic hernia (CDH) remains a life-threatening neonatal condition, particularly in resource-limited settings without access to extracorporeal membrane oxygenation (ECMO). Early identification of prognostic markers may improve risk stratification and clinical decision-making. This study evaluated the association of oxygenation index (OI), defect size, and perioperative characteristics with in-hospital mortality in surgically treated neonates with CDH at a national referral center in Ecuador.

Methods

We conducted an observational, cross-sectional study of 40 neonates who underwent surgical repair of CDH between January 2019 and January 2024. Demographic, clinical, perioperative, and postoperative variables were obtained from anonymized medical records. Associations between OI category (< 40 vs. > 40) and clinical characteristics were assessed using the chi-square test or Fisher exact test, as appropriate. Crude odds ratios were calculated for clinically relevant variables, and multivariable logistic regression was used to examine the association of OI and defect size with in-hospital mortality.

Results

Of the 40 neonates included, 31 (77.5%) had OI < 40 and 9 (22.5%) had OI > 40. Comorbidities were more frequent in the OI > 40 group than in the OI < 40 group (100% vs. 61.29%; p = 0.037). Defect size showed a borderline association with higher OI (p = 0.057), with C + D defects more common among neonates with OI > 40. Surgical approach also differed according to OI category, with open repair more frequent in the OI > 40 group (p = 0.044). Overall, in-hospital mortality was 35%. In the adjusted model, C + D defect size was associated with higher odds of mortality (odds ratio, 24.99; p = 0.033), whereas OI was not significantly associated with death.

Conclusion

In this cohort of surgically treated neonates with CDH, larger defect size was associated with greater respiratory severity and higher in-hospital mortality. OI reflected early clinical compromise but was not independently associated with mortality in the adjusted analysis. These findings support the clinical value of standardized defect classification as part of early risk assessment in resource-limited settings without ECMO.