The efficacy of the postnatal nasogastric tube position as a prognostic marker of left-sided isolated congenital diaphragmatic hernia

• Published in: Pediatric surgery international Vol. 38; no. 12; pp. 1873 - 1880
• Main Authors: Kono, Jun, Nagata, Kouji, Terui, Keita, Amari, Shoichiro, Toyoshima, Katsuaki, Inamura, Noboru, Koike, Yuhki, Yamoto, Masaya, Okazaki, Tadaharu, Yazaki, Yuta, Okuyama, Hiroomi, Hayakawa, Masahiro, Furukawa, Taizo, Masumoto, Kouji, Yokoi, Akiko, Usui, Noriaki, Tajiri, Tatsuro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2022; Springer Nature B.V
• Subjects: Hernias; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Surgery; Stomach position; Congenital diaphragmatic hernia; Postnatal prognostic factor; Mortality; Nasogastric tube
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-022-05226-8

Purpose
The prenatal diagnosis of the stomach position in congenital diaphragmatic hernia (CDH) has been a reliable prognostic factor, but few studies have focused on the postnatal position. We therefore evaluated the significance of the nasogastric (NG) tube position just after birth.
Methods
The Japanese CDH Study Group database enrolled 1037 CDH neonates over 15 years. In our multicenter retrospective study, 464 cases of left-sided isolated CDH with prenatal diagnoses were divided into two groups: NG tube below the diaphragm (BD;
n
 = 190) or above the diaphragm (AD;
n
 = 274). The primary outcome was the 90-day survival rate, and the secondary outcomes were mechanical ventilation duration, hospitalization duration, and recurrence rate.
Results
The BD group had a significantly higher 90-day survival rate (98.4 vs. 89.4%,
p
 < 0.001), shorter mechanical ventilation (11 vs. 19 days,
p
 < 0.001), shorter hospitalization (38 vs. 59 days,
p
 < 0.001), and lower recurrence rate (
p
 = 0.002) than the AD group. A multivariate analysis showed that BD (adjusted odds ratio, 3.68; 95% confidence interval 1.02–13.30) was a favorable prognostic factor for the 90-day survival.
Conclusion
The assessment of the NG tube position revealed it to be a reliable prognostic factor of left-sided isolated CDH. Therefore, it should be included as a routine assessment.