PDF(Pubmed)
Abstract：
Congenital diaphragmatic hernia (CDH) is a life-threatening condition characterized by the herniation of abdominal organs into the thorax, resulting in hypoplastic lungs and pulmonary hypertension. The impact of the first cry, a crucial event for lung transition during birth, on CDH patients remains unclear. This study investigated the impact of the first cry during birth on CDH patient survival, along with other prognosis factors. A multi-institutional retrospective study assessed CDH patient characteristics and survival rates by analyzing factors including the first cry, disease severity, birth weight, Apgar scores, oxygenation index (OI) and surgical closure. Among the CDH patients in the study, a positive first cry was linked to 100% survival, regardless of disease severity (p < 0.001). Notably, the presence of a positive first cry did not significantly affect survival rates in patients with worse prognostic factors, such as low birth weight (<2500 g), high CDH severity, low Apgar scores (1 min ≤ 4), high best OI within 24 h after birth (≥8), or those who underwent patch closure. Furthermore, no significant association was found between the first cry and the use of inhaled nitric oxide (iNO) or extracorporeal membrane oxygenation (ECMO). In conclusion, this study suggests that the first cry may not have a negative impact on the prognosis of CDH patients and could potentially have a positive effect.
摘要：
先天性膈疝（CDH）是一种危及生命的疾病，其特征是腹部器官疝入胸腔，导致肺发育不良和肺动脉高压。第一次哭泣的影响，出生期间肺转变的关键事件，CDH患者尚不清楚。这项研究调查了出生时第一次哭泣对CDH患者生存的影响，以及其他预后因素。一项多机构回顾性研究通过分析包括首次哭泣在内的因素来评估CDH患者的特征和生存率。疾病严重程度,出生体重,阿普加得分,氧合指数（OI）和手术闭合。在研究中的CDH患者中，积极的第一次哭泣与100%的生存有关，无论疾病严重程度如何（p<0.001）。值得注意的是,在预后因素较差的患者中，首次哭泣的阳性并没有显着影响生存率，例如低出生体重（<2500克），高CDH严重程度，低Apgar评分（1分钟≤4），出生后24小时内最高的最佳OI（≥8），或者那些接受了补丁关闭的人。此外，首次哭泣与使用吸入一氧化氮(iNO)或体外膜氧合(ECMO)之间未发现显著关联.总之,这项研究表明,第一次哭泣可能不会对CDH患者的预后产生负面影响,并且可能会产生积极影响.
