Background: Congenital diaphragmatic hernia (CDH) has high morbidity and mortality. Many outcome predictors have been tried. Objective: To assess the short-term outcomes of neonates with isolated CDH and find the predictors of outcome. Methods: Neonates with isolated CDH managed over 12-year period from June 2004 were analyzed. Antenatal counseling, delayed surgery after stabilization, primary conventional ventilation and rescue high frequency ventilation if needed is the unit protocol. Details on baseline characteristics, delivery room management, clinical details, ventilation details, management of pulmonary hypertension, inhaled nitric oxide usage, operative details, and post-operative period were noted. Oxygenation index (OI) was calculated, and echocardiography findings on pulmonary hypertension were noted. Outcome predictors were assessed. Results: 40 neonates with isolated CDH were managed during the study period. The mean birth weight and gestation were 37.7±1.55 weeks and 2830±480 g, respectively. The majority of them were intramural and had an antenatal diagnosis. Definitive sepsis, pneumothorax, and severe pulmonary hypertension were seen in 10, 9, and 17 neonates, respectively. In 32 neonates, surgical repair was done and 31 (78%) survived at discharge. Median (range) of maximum OI on day 1 was 6 (2.2-39) and 59.9 (7.65-96) for survivors and non-survivors,respectively. Area under the curve (AUC) for OI prediction of survival was 0.94 (confidence interval 0.86-0.99). The adjusted odds ratio for survival, when maximum OI was below 15, was 36.2 (4.6-142). Receiver operating curve showed AUC for OI in predicting survival was 0.95 (0.86-0.99). Conclusion: We found 78% survival for isolated CDH neonates using standard protocol and OI is a good predictor for survival.

INTRODUCTIONSeizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome.1-4 A specific etiology for the seizure can be better detected in infants compared to children. 5However in 12-15% of newborns the etiology remains unknown.6-8 Magnetic resonance imaging (MRI) is a valuable tool for identifying structural abnormalities which may be the underlying etiology for neonatal seizures and it is also more sensitive to detect subtle changes compared to neurosonogram or computed tomography. 9 In developed countries, MRI of brain has become a standard investigation over a period of time but not yet in developing countries due to the lack of availability of equipment and expertise.7,10 MRI is not only helpful to detect the underlying brain etiology but also to prognosticate. 11Data on MRI findings in neonatal seizures are sparse in developing countries. Hence the objective of this study is ABSTRACT Background: Seizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome. The aim of the study was to describe the spectrum of brain lesions identified by magnetic resonance imaging (MRI) in term babies presenting with neonatal seizures. Methods: This retrospective descriptive study was done in a tertiary care hospital. The study subjects included term neonates presenting with neonatal seizures admitted in neonatal intensive care unit over a 5 year period, who underwent MRI brain. Data was collected from the medical records and radiology department. Results: Out of 189 neonates presenting with seizures, 155 underwent MRI brain. Brain lesions were identified in 122 (79%) babies. The most common etiological diagnosis was hypoxic ischemic encephalopathy (HIE) which was noted in 43 (28%) neonates. The other findings in the decreasing order were encephalitis in 35 (23%), metabolic disorder in 16 (10%), haemorrhage in 15 (9.7%) vascular in 12 (8%) and cortical dysplasia in 1 (<1%) neonates. Conclusions: MRI identified brain lesions in 79% of infants who presented with neonatal seizures. In accordance with the literature, our studies also revealed HIE as the commonest brain lesion. The diagnosis of neonatal stroke and encephalitis was made specifically with the aid of MRI. MRI showed changes consistent with diagnosis of encephalitis in a significant proportion of babies. We suggest that MRI should be considered as a standard investigation during the evaluation and management of neonatal seizures.

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