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Enteric tube position on preoperative radiographs predicts clinical outcomes in neonatal congenital diaphragmatic hernia with and without prenatal diagnosis

Journal of Perinatology volume 43, pages 1131–1138 (2023)Cite this article

Subjects

Abstract

Objective

Congenital Diaphragmatic Hernia (CDH) is diagnosed prenatally in ~60% of cases. Prenatal measures typically guide management and prognostication. Simple postnatal prognosticators are needed when prenatal diagnosis is lacking. We hypothesized that preoperative orogastric tube (OGT) tip position relative to the contralateral diaphragm correlates with defect severity, resource utilization, and clinical outcomes regardless of diagnostic status.

Study design

150 neonates with left-posterolateral CDH were analyzed. Impact of intrathoracic and intraabdominal preoperative tip position on clinical outcomes was compared.

Results

Ninety-nine neonates were prenatally diagnosed. Overall, intrathoracic position significantly correlated with larger diaphragmatic defects, advanced postnatal pulmonary support requirements (HFOV, pulmonary vasodilators, and ECMO), operative complexity, longer hospitalization, and poorer survival to discharge. These observations persisted when analyzing only cases lacking prenatal diagnosis.

Conclusions

Preoperative OGT tip position predicts defect severity, resource utilization, and outcomes in CDH. This observation enhances postnatal prognostication and care planning for neonates without a prenatal diagnosis.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Vanderbilt University School of Medicine, Nashville, TN, USA

    Marshall W. Wallace & Jan A. Niec

  2. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Muhammad B. Mirza & Meredith A. Achey

  3. Department of Radiology, Children’s Hospital at Erlanger, Chattanooga, TN, USA

    Joseph Oros

  4. Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    Melissa E. Danko & Harold N. Lovvorn III

  5. Division of Pediatric Radiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    Melissa A. Hilmes

  6. Division of Neonatology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    L. Dupree Hatch & Emily A. Morris

Authors
  1. Marshall W. Wallace
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  2. Jan A. Niec
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  3. Muhammad B. Mirza
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  4. Meredith A. Achey
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  7. Melissa A. Hilmes
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  8. L. Dupree Hatch
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  10. Harold N. Lovvorn III
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Contributions

All authors meet authorship criteria according to the ICMJE [27]. MW, JM, MA, JO and HL designed the experiment, collected data and critically revised and approved of the manuscript. MD, MH, LH and EM designed the experiment and critically revised and approved of the manuscript.

Corresponding author

Correspondence to Marshall W. Wallace.

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Competing interests

The authors, Dr. Wallace, Dr. Niec, Dr. Achey, Dr. Danko, Dr. Oros, Dr. Hilmes, Dr. Hatch, Dr. Morris, and Dr. Lovvorn have no competing interests.

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Wallace, M.W., Niec, J.A., Mirza, M.B. et al. Enteric tube position on preoperative radiographs predicts clinical outcomes in neonatal congenital diaphragmatic hernia with and without prenatal diagnosis. J Perinatol 43, 1131–1138 (2023). https://doi.org/10.1038/s41372-023-01712-6

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  • DOI: https://doi.org/10.1038/s41372-023-01712-6

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