Effect of multidisciplinary treatment on outcomes in infants with congenital diaphragmatic hernia: 10-year experience

Objective To summarize our experiences of multidisciplinary treatment (MDT) for infants with congenital diaphragmatic hernia (CDH) and explore its effect on outcomes. Methods The medical records were retrospectively reviewed for 152 CDH infants from January 2001 to December 2018. The relevant clinical data included gestational age at diagnosis and delivery, Apgar score, types of hernia, birth weight, site of liver, admission arterial blood gas analysis, types of surgery, duration of mechanical ventilation and length of hospital stay. They were divided into two groups of non-MDT from January 2001 to February 2008 (n=8) and MDT from March 2008 to December 2018 (n=144). Their clinical parameters were compared and analyzed. Results There were 80 boys and 72 girls. And the involved side was left (n=120) and right (n=32). A total of 135 children were operated. In non-MDT group, all patients underwent open surgery. In MDT group, 17 patients died of cardiorespiratory failure without surgery. Among 127 surgical infants, open (n=66) and mini-invasive (n=78) operations were performed. Compared with counterparts in non-MDT group, those infants in MDT group were more likely to delay in surgical timing [(4.8±2.3) vs. (1.1±0.4) days], higher utilization of thoracoscopy (0 vs. 48.0%) and a higher survival rate (75.0% vs. 37.5%)(all P<0.05). However, no inter-group differences existed in gender, birth weight, site/size of defect, types of surgery or prenatal diagnosis. Conclusions MDT provides an feasible and effective model for diagnosing and treating CDH with better outcomes. Key words: Hernia, diaphragmatic; Multidisciplinary treatment; Treatment model; Prognosis