{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:52:04Z","timestamp":1785912724499,"version":"3.56.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly associated with high neonatal morbidity and mortality. Evidence from low- and middle-income countries remains limited. This study aimed to identify clinical predictors of mortality and describe outcomes in neonates with CDH treated at a high-complexity center in Colombia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:bold>R<\/jats:bold>\n                      etrospective cohort study including all neonates with confirmed CDH managed between May 2007 and February 2026. The main outcome was in-hospital mortality. Prenatal, neonatal, respiratory, surgical, and clinical management variables were analyzed. Multivariable Poisson regression was performed among patients undergoing surgical repair.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>91 neonates were included, with an overall survival of 54.9% (95% CI 44.5\u201364.9). Prenatal diagnosis was established in 74.7% of cases, and 68.1% of patients achieved sufficient stabilization to undergo surgical repair. Non-survivors had higher rates of perinatal asphyxia and lower birth weight and gestational age. Patients undergoing surgical repair showed significantly better initial oxygenation and gas exchange parameters. Among surgically treated patients, mortality was associated with non-primary repair, larger defect size, absence of hernia sac, delayed abdominal closure, and postoperative complications. In multivariable analysis, perinatal asphyxia (RR 6.1, 95% CI 2.34\u201316.1), intrathoracic liver position (RR 5.1, 95% CI 1.37\u201319.1) and left ventricular dysfunction (RR 4.0 95% CI 1.07\u201314.9) were independently associated with mortality, while higher birth weight was protective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We noted high mortality in this cohort in Colombia. Early markers of cardiopulmonary severity and anatomical severity were strongly associated with mortality, highlighting the importance of prenatal risk stratification and early multidisciplinary stabilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1907855","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:28:35Z","timestamp":1785911315000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical determinants of mortality in congenital diaphragmatic hernia: a single-center cohort study from Colombia"],"prefix":"10.3389","volume":"14","author":[{"given":"Jorge","family":"Alvarado-Socarras","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Otoya-Castrillon","sequence":"additional","affiliation":[{"name":"Pediatric Surgeon, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia C.","family":"Colmenares-Mej\u00eda","sequence":"additional","affiliation":[{"name":"Research Institute, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris C.","family":"Quintero-Lesmes","sequence":"additional","affiliation":[{"name":"Research Institute, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s Felipe","family":"Rubio-Duarte","sequence":"additional","affiliation":[{"name":"Epidemiology and Data Analysis Unit, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar Fabian","family":"Manrique-Hernandez","sequence":"additional","affiliation":[{"name":"Epidemiology and Data Analysis Unit, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Candia","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Intensive Care Unit, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica","family":"Ortiz-Cordoba","sequence":"additional","affiliation":[{"name":"ECMO and Ventricular Assistance Program, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Ballesteros-Trillos","sequence":"additional","affiliation":[{"name":"ECMO and Ventricular Assistance Program, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Duran-Hernandez","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Intensive Care Unit, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Salazar-Rojas","sequence":"additional","affiliation":[{"name":"ECMO and Ventricular Assistance Program, Hospital Internacional de Colombia HIC, Fundaci\u00f3n Cardiovascular de Colombia FCV, Fundaci\u00f3n Universitaria FCV","place":["Santander, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1038\/S41372-023-01789-Z","article-title":"Organization of care of infants with congenital diaphragmatic hernia-building a high-functioning CDH program","volume":"44","author":"Fernandes","year":"2024","journal-title":"J Perinatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.21037\/tp-23-240","article-title":"Recent advances in the treatment of complex congenital diaphragmatic hernia-a narrative review","volume":"12","author":"Holden","year":"2023","journal-title":"Transl Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e000892","DOI":"10.1136\/WJPS-2024-000892","article-title":"Prenatal diagnosis and risk stratification of congenital diaphragmatic hernia","volume":"7","author":"Abbasi","year":"2024","journal-title":"World J Pediatr Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1177\/19345798241308462","article-title":"An evidence-based treatment algorithm for congenital diaphragmatic hernia","volume":"17","author":"Stewart","year":"2024","journal-title":"J Neonatal Perinatal Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.jss.2019.05.007","article-title":"Toward standardized management of congenital diaphragmatic hernia: an analysis of practice guidelines","volume":"243","author":"Jancelewicz","year":"2019","journal-title":"J Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/PED.14473","article-title":"Clinical guidelines for the treatment of congenital diaphragmatic hernia","volume":"63","author":"Ito","year":"2021","journal-title":"Pediatr Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/AJE\/KWH090","article-title":"A modified poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1016\/S0895-4356(01)00341-9","article-title":"Internal validation of predictive models: efficiency of some procedures for logistic regression analysis","volume":"54","author":"Steyerberg","year":"2001","journal-title":"J Clin Epidemiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1016\/j.jpedsurg.2023.01.058","article-title":"Risk-stratified results among congenital diaphragmatic hernia patients in two large extracorporeal membrane oxygenation centers in South America","volume":"58","author":"Luco","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"784810","DOI":"10.3389\/FPED.2021.784810","article-title":"Knowledge gaps in the fetal to neonatal transition of infants with a congenital diaphragmatic hernia","volume":"9","author":"DeKoninck","year":"2021","journal-title":"Front Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0281723","DOI":"10.1371\/JOURNAL.PONE.0281723","article-title":"Congenital diaphragmatic hernia in a middle-income country: persistent high lethality during a 12-year period","volume":"18","author":"Scavacini Marinonio","year":"2023","journal-title":"PLoS One"},{"key":"B12","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/J.ACMX.2013.07.010","article-title":"Current state of neonatal extracorporeal membrane oxygenation in Colombia: description of the first cases","volume":"84","author":"Alvarado-Socarr\u00e1s","year":"2014","journal-title":"Arch Cardiol Mex"},{"key":"B13","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1159\/000444210","article-title":"Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO consortium consensus - 2015 update","volume":"110","author":"Snoek","year":"2016","journal-title":"Neonatology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"151443","DOI":"10.1016\/j.sempedsurg.2024.151443","article-title":"Long-term follow-up in congenital diaphragmatic hernia","volume":"33","author":"Pollack","year":"2024","journal-title":"Semin Pediatr Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1177\/08850666231212874","article-title":"Update on management and outcomes of congenital diaphragmatic hernia","volume":"39","author":"Wild","year":"2024","journal-title":"J Intensive Care Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1136\/ARCHDISCHILD-2023-325865","article-title":"Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian congenital diaphragmatic hernia collaborative","volume":"109","author":"Puligandla","year":"2024","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B17","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1007\/S13312-025-00240-0","article-title":"Guidelines for the medical management of congenital diaphragmatic hernia: implications for resource-limited settings","volume":"63","author":"Singh","year":"2026","journal-title":"Indian Pediatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"315","DOI":"10.3390\/CHILDREN10020315","article-title":"Congenital diaphragmatic hernia: perinatal prognostic factors and short-term outcomes in a single-center series","volume":"10","author":"Pagliara","year":"2023","journal-title":"Children"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1515\/JPM-2025-0195","article-title":"Incidence and mortality trends in congenital diaphragmatic hernia in the United States","volume":"53","author":"Shah","year":"2025","journal-title":"J Perinat Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1002\/PD.6365","article-title":"Neonatal outcomes of congenital diaphragmatic hernia in full term versus early term deliveries: a systematic review and meta-analysis","volume":"43","author":"Mimura","year":"2023","journal-title":"Prenat Diagn"},{"key":"B21","doi-asserted-by":"publisher","first-page":"173","DOI":"10.5546\/aap.2020.173","article-title":"Hernia diafragm\u00e1tica cong\u00e9nita: predictores posnatales de mortalidad\/Congenital diaphragmatic hernia: postnatal predictors of mortality","volume":"118","author":"Salas","year":"2020","journal-title":"Arch Argent Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1002\/UOG.7586","article-title":"Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis","volume":"35","author":"Mullassery","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1038\/S41372-022-01485-4","article-title":"Prenatal markers in congenital diaphragmatic hernia-can we accurately predict outcomes?","volume":"42","author":"Fletcher","year":"2022","journal-title":"J Perinatol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"151438","DOI":"10.1016\/j.sempedsurg.2024.151438","article-title":"Cardiac function in congenital diaphragmatic hernia","volume":"33","author":"Altit","year":"2024","journal-title":"Semin Pediatr Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/J.ANPEDI.2024.04.014","article-title":"Hernia diafragm\u00e1tica cong\u00e9nita: relaci\u00f3n entre el tama\u00f1o del defecto y evoluci\u00f3n. Experiencia en un centro de referencia","volume":"101","author":"Ota\u00f1o","year":"2024","journal-title":"An Pediatr (Engl Ed)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/S00431-020-03779-1","article-title":"Congenital diaphragmatic hernia-does the presence of a hernia sac improve outcome? A systematic review of published studies","volume":"180","author":"Raitio","year":"2021","journal-title":"Eur J Pediatr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"12661","DOI":"10.1038\/s41598-021-91908-7","article-title":"A systematic review and meta-analysis of surgical morbidity of primary versus patch repaired congenital diaphragmatic hernia patients","volume":"11","author":"Heiwegen","year":"2021","journal-title":"Sci Rep"},{"key":"B28","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.jpedsurg.2016.10.010","article-title":"Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors?","volume":"52","author":"Shieh","year":"2017","journal-title":"J Pediatr Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1907855\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:28:36Z","timestamp":1785911316000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1907855\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":28,"alternative-id":["10.3389\/fped.2026.1907855"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1907855","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"1907855"}}