{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:14:41Z","timestamp":1791980081814,"version":"4.4.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NPM"],"published-print":{"date-parts":[[2022,12,23]]},"abstract":"<jats:p>BACKGROUND: While physiologic stabilization followed by repair has become the accepted paradigm for management of congenital diaphragmatic hernia (CDH), few studies have examined the effect of incremental changes in operative timing on patient outcomes. We hypothesized that later repair would be associated with higher morbidity and mortality. METHODS: Data were queried from the CDH Study Group (CDHSG) from 2007-2020. Patients with chromosomal or cardiac abnormalities and those who were never repaired or required pre-repair extra-corporeal life support (ECLS) were excluded. Time to repair was analyzed both as a continuous variable and by splitting the cohort into top\/bottom percentiles. The primary outcome of interest was in-hospital mortality. Secondary outcomes included need for and duration of post-repair ventilatory and nutritional support. RESULTS: A total of 4,104 CDH infants were included. Median time to repair was 4 days (IQR 2\u20136). On multivariable analysis, high-risk (CDHSG stage C\/D) defects and lower birthweight predicted later repair. Overall, in-hospital mortality was 6%. On univariate analysis, there was no difference in the number of days to repair between survivors and non-survivors. On risk-adjusted analysis, single-day changes in day of repair were not associated with increased mortality. Later repair was associated with longer time to reach full oral feeds, increased post-repair ventilator days, and increased need for tube feeds and supplementary oxygen at discharge. CONCLUSIONS: For infants with isolated CDH not requiring pre-operative ECLS, there is no difference in mortality based on timing of repair, but single-day delays in repair are associated with increased post-repair duration of ventilatory and nutritional support.<\/jats:p>","DOI":"10.3233\/npm-221072","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T10:44:40Z","timestamp":1669977880000},"page":"759-765","source":"Crossref","is-referenced-by-count":12,"title":["Association of timing of congenital diaphragmatic hernia repair with survival and morbidity for patients not requiring extra-corporeal life support"],"prefix":"10.1177","volume":"15","author":[{"given":"V.S.","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children\u2019s Memorial Hermann Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.T.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Department of Urology, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.H.","family":"Ebanks","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children\u2019s Memorial Hermann Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.P.","family":"Lally","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children\u2019s Memorial Hermann Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.T.","family":"Harting","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children\u2019s Memorial Hermann Hospital, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.A.","family":"Basir","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"issue":"3","key":"10.3233\/NPM-221072_ref1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1053\/j.sempedsurg.2017.04.004","article-title":"Congenital diaphragmatic hernia: The role of multi-institutional collaboration and patient registries in supporting best practice","volume":"26","author":"Lally","year":"2017","journal-title":"Semin Pediatr Surg"},{"issue":"83","key":"10.3233\/NPM-221072_ref2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1002\/bjs.1800218308","article-title":"The pathology, diagnosis, and treatment of congenital diaphragmatic hernia in infants","volume":"21","author":"Barrett","year":"1934","journal-title":"BJS"},{"issue":"3","key":"10.3233\/NPM-221072_ref3","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/S0022-3476(87)80475-4","article-title":"Effect of surgical repair on respiratory mechanics in congenital diaphragmatic hernia","volume":"111","author":"Sakai","year":"1987","journal-title":"J Pediatr"},{"issue":"8","key":"10.3233\/NPM-221072_ref4","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S0022-3468(88)80413-5","article-title":"Timing of surgery for congenital diaphragmatic hernia: Is emergency operation necessary?","volume":"23","author":"Langer","year":"1988","journal-title":"J Pediatr Surg"},{"issue":"2","key":"10.3233\/NPM-221072_ref5","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.surg.2014.04.015","article-title":"A risk-stratified analysis of delayed congenital diaphragmatic hernia repair: Does timing of operation matter?","volume":"156","author":"Hollinger","year":"2014","journal-title":"Surgery"},{"issue":"12","key":"10.3233\/NPM-221072_ref7","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1016\/j.jpedsurg.2013.08.014","article-title":"Standardized reporting for congenital diaphragmatic hernia- an international consensus","volume":"48","author":"Lally","year":"2013","journal-title":"J Pediatr Surg"},{"issue":"11","key":"10.3233\/NPM-221072_ref8","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1016\/j.jpedsurg.2018.06.003","article-title":"Outcomes of infants with congenital diaphragmatic hernia treated with venovenous versus venoarterial extracorporeal membrane oxygenation: A propensity score approach","volume":"53","author":"Guner","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"1","key":"10.3233\/NPM-221072_ref9","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1053\/jpsu.2001.20032","article-title":"Estimating disease severity of congenital diaphragmatic hernia in the first 5 minutes of life","volume":"36","author":"Congenital Diaphragmatic Hernia Study Group","year":"2001","journal-title":"J Pediatr Surg"},{"issue":"12","key":"10.3233\/NPM-221072_ref10","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/j.jpedsurg.2017.08.037","article-title":"Cannulating the contraindicated: Effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation","volume":"52","author":"Delaplain","year":"2017","journal-title":"J Pediatr Surg"},{"issue":"12","key":"10.3233\/NPM-221072_ref11","first-page":"1522","article-title":"Ventricular dysfunction is a critical determinant of mortality in congenital diaphragmatic hernia","volume":"200","author":"Patel","year":"2019","journal-title":"AJRCCM"},{"issue":"1","key":"10.3233\/NPM-221072_ref12","doi-asserted-by":"crossref","first-page":"151167","DOI":"10.1053\/j.semperi.2019.07.006","article-title":"Congenital diaphragmatic hernia-associated pulmonary hypertension","volume":"44","author":"Gupta","year":"2020","journal-title":"Semin Perinatol"},{"issue":"5","key":"10.3233\/NPM-221072_ref13","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/S0022-3476(05)80048-4","article-title":"Effect of preoperative stabilization on respiratory system compliance and outcome in newborn infants with congenital diaphragmatic hernia","volume":"118","author":"Nakayama","year":"1991","journal-title":"J Pediatr"},{"issue":"5","key":"10.3233\/NPM-221072_ref14","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/0022-3468(94)90725-0","article-title":"A prospective randomized trial of delayed versus immediate repair of congenital diaphragmatic hernia","volume":"29","author":"Nio","year":"1994","journal-title":"J Pediatr Surg"},{"issue":"2","key":"10.3233\/NPM-221072_ref15","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00383-016-4003-1","article-title":"Appropriate timing of surgery for neonates with congenital diaphragmatic hernia: Early or delayed repair?","volume":"33","author":"Okuyama","year":"2017","journal-title":"Pediatr Surg Int"},{"issue":"11","key":"10.3233\/NPM-221072_ref17","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1016\/j.jpedsurg.2015.09.010","article-title":"Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee","volume":"50","author":"Puligandla","year":"2015","journal-title":"J Pediatr Surg"},{"issue":"4","key":"10.3233\/NPM-221072_ref18","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1097\/SLA.0b013e3182a53c49","article-title":"Long-term maturation of congenital diaphragmatic hernia treatment results: Toward development of a severity-specific treatment algorithm","volume":"258","author":"Kays","year":"2013","journal-title":"Ann Surg"},{"issue":"4","key":"10.3233\/NPM-221072_ref19","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.jpedsurg.2009.08.011","article-title":"Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation","volume":"45","author":"Dassinger","year":"2010","journal-title":"J Pediatr Surg"},{"issue":"5","key":"10.3233\/NPM-221072_ref20","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1097\/SLA.0000000000002144","article-title":"Aggressive surgical management of congenital diaphragmatic hernia: worth the effort? A multicenter, prospective, cohort study","volume":"267","author":"Harting","year":"2018","journal-title":"Ann Surg"}],"container-title":["Journal of Neonatal-Perinatal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/NPM-221072","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:42:37Z","timestamp":1777614157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.medra.org\/servlet\/aliasResolver?alias=iospress&doi=10.3233\/NPM-221072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,23]]},"references-count":18,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3233\/npm-221072","relation":{},"ISSN":["1934-5798","1878-4429"],"issn-type":[{"value":"1934-5798","type":"print"},{"value":"1878-4429","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,23]]}}}