Epidemiological status and infant outcomes of congenital diaphragmatic hernia in Beijing from 2018 to 2022
10.3760/cma.j.cn113903-20240511-00342
- VernacularTitle:北京市2018年至2022年先天性膈疝的流行病学现状及婴儿期转归
- Author:
Wen ZHANG
1
;
Hongyan XU
1
;
Xiaozheng CHEN
1
;
Yanchun ZHANG
1
;
Kaibo LIU
1
Author Information
1. 首都医科大学附属北京妇产医院/北京妇幼保健院围产保健科，北京 100026
- Publication Type:Journal Article
- Keywords:
Congenital diaphragmatic hernia;
Occurrence;
Prenatal diagnosis;
Infant mortality
- From:
Chinese Journal of Perinatal Medicine
2024;27(12):1001-1006
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the epidemiology, and infant outcomes of congenital diaphragmatic hernia (CDH) in Beijing.Methods:This retrospective study involved cases diagnosed with CDH among 877 230 fetuses/infants monitored by the Beijing Birth Defects Monitoring System from January 2018 to December 2022. Data on the occurrence of CDH, prenatal diagnosis, and infant mortality were analyzed. The statistical method was the Chi-square test (or Fisher's exact test). Results:(1) A total of 254 CDH cases were included in this study. During the study period, the incidence of CDH throughout the pregnancy and the perinatal period was 0.29 per thousand (254/877 230) and 0.17 per thousand (153/877 230), respectively. (2) Among the 254 cases, 79 (31.1%) underwent prenatal genetic diagnosis, 6.3%(5/79) copy number varations were detected, including one case of like pathogenic and four cases with types of variation unreported. The proportions of prenatal genetic diagnosis from 2018 to 2022 showed no statistically significant difference ( χ2trend=2.86, P=0.091). The gestational age at prenatal diagnosis for 241 cases was (23.0±6.4) weeks, ranging from 13 to 38 weeks; 130 cases (53.9%) were diagnosed before 25 weeks of gestation. The proportion of genetic diagnosis was higher in the group diagnosed by ultrasound before 25 weeks (43.1%, 56/130) compared to the group diagnosed at or after 25 weeks (20.7%, 23/111) ( χ2=12.59, P<0.001). (3) A total of 146 live births were recorded, with the proportion of continuing pregnancy to live birth after prenatal diagnosis being 55.2% (133/241), with no significant difference across the years. The proportion of continuing pregnancy to live birth after prenatal diagnosis in the isolated CDH group was 64.5% (100/155), higher than the 38.3% (33/86) in the non-isolated group ( χ2=15.57, P<0.001). The live birth rate for those diagnosed prenatally at<25 weeks of gestation (26.2%, 34/130) was lower than for those diagnosed at≥25 weeks of gestation (89.2%, 99/111) ( χ2=93.67, P<0.001). (4) Among the 146 live-born infants, 28 (19.2%) died during infancy. All 28 cases were prenatally diagnosed with CDH. The mortality rate of CDH infants born in tertiary obstetric institutions (17.9%, 24/134) showed a trend towards being lower than that in secondary institutions (4/12), but the difference was not statistically significant (Fisher's exact test, P=0.245). Among the 118 surviving infants, seven were abandoned from treatment, and of the remaining 111, 104 (93.7%) were treated at the Children's Hospital, Capital Institute of Pediatrics. The infant mortality rate at this institution (15.4%, 16/104) showed a trend towards being lower than that at other institutions (3/7), but the difference was not statistically significant (Fisher's exact test, P=0.096). The infant mortality rate for those diagnosed prenatally at<25 weeks of gestation (38.2%, 13/34) was higher than for those diagnosed at≥25 weeks of gestation (15.2%, 15/99) ( χ2=6.78, P=0.009). Conclusions:Beijing achieved good secondary and tertiary prevention outcomes in prenatal diagnosis and reducing infant mortality. The concentration of neonatal surgical resources is beneficial for accumulating surgical experience and reducing infant mortality.
