Background: Congenital diaphragmatic hernia (CDH) is a common congenital anomaly with significant morbidity and mortality. Few surveys have been reported regarding the prenatal status, clinical course and postnatal outcome of CDH. The symptoms and prognosis depend on the location of the defect and associated anomalies. Objectives: The aim of this study was to examine the effect of clinical factors on the prognosis of CDH in our pediatric hospital. Methods: We analyzed 74 records of CDH neonates referred to our center for surgery between 2008 and 2015. We investigated the associated factors with the outcomes of CDH using the information extracted from the hospital records. The perinatal status, clinical course and the postnatal outcome were reviewed. Survival was defined as infants alive at hospital discharge. Results: A total of 74 CDH cases were identified. Of these, 27 (36.5%) cases were females and 47 (63.5%) males. The type of hernia in 73 (98.6%) cases was Bochdaleck and 1 (1.4%) case was Morgagni. Seventeen (23.9%) cases had right-sided CDH and 57 (76.1%) cases left-sided CDH. Also, 90.5% underwent open surgery and 9.5% thoracoscopic repair. Forty-seven (63.5%) cases survived and 27 (36.5%) cases succumbed. The survival rate had a significant statistical correlation with the place of delivery. The death rate was higher in neonates referred from other hospitals in our town in comparison to other cities (P = 0.008). Also, the resuscitation history, the status at admission (intubated or not intubated) (P = 0.00), existence of skeletal anomalies (P = 0.02) and brain hemorrhage (P = 0.045) had a significant correlation with the survival rate. The side of herniation, herniated organs, type of operation (open or thoracoscopic), cardiac and renal anomalies and age at the time of surgery had no significant correlation with outcome. Conclusions:The overall mortality rate in CDH was high in our series. Neonates with CDH should be delivered in institutes with the neonatal intensive care unit and surgery ward to prevent complications. To achieve better survival rates, pulmonary hypertension should intensively be controlled and the extracorporeal membrane oxygenation should be used in selected cases.

Background: Sepsis is one of the most common causes of neonatal mortality and morbidity in NICUs. Prescription of broadspectrum antibiotics is increasing; hence, increase in antibiotic resistance is a concern. Information about changing microbial patterns and antimicrobial sensitivity over time helps us to choose the most appropriate antibiotics. Objectives: The aim of this research was to assess the changing microbial patterns and antibiotic susceptibility during a 23-year interval from 1992 to 2015 in the NICU of the Mofid Children's hospital in Tehran, Iran. Methods: We conducted a retrospective comparative descriptive study between 1992 and 2015. Neonates with positive blood cultures were enrolled, and the microbial characteristics and antibiograms of the blood cultures were compared. Results: One-hundred cases of positive blood cultures in 1992 and 103 cases in 2015 were analyzed and compared. Overall, 57% of neonates were male and 43% were female; 56% of the sepsis was late onset and 44% was early onset; 63% of neonates had term gestation and 37% were preterm. We found that the most common causes of positive blood culture isolated in 1992 were Staphylococcus aureus (59%) and Staphylococcus epidermidis (40.9%). In 2015, the most common causes were (coagulase negative staphylococci) CONS (33.98%) and Pseudomonas aeruginosa (20.3%). In the evaluation of antibiograms, the rate of resistance to cephalosporins, aminoglycosides (except tobramycin), and oxacillins increased from 1992 to 2015. In 2015, the sensitivity rate to imipenem, meropenem, ciprofloxacillin, vancomycin, and linezolid was greater than the resistance, whereas to piperacillin, colistin, and cefepim, and cefotaxim, the rate of resistance was higher. In the evaluation of antibiotic sensitivity based on microorganisms in 2015, piperacillin had the highest effectiveness against pseudomonas and Klebsiella, with no effectiveness against Acinetobacter. Ciprofloxacin had the highest effectiveness against E. coli and Klebsiella. One-hundred percent of Streptococci, 83.3% of Staphylococcus aureus, and 71.4% of coagulase negative Staphylococci were sensitive to vancomycin. Conclusions: In this research, we found that the pattern of microbial and antibiotic sensitivity has changed, and overall antibiotic resistance is increasing. This is an indication that healthcare providers should use broad-spectrum antibiotics with caution.