Congenital Diaphragmatic Hernia – Analysis of Possible Prognostic Factors Predicting the Outcome

Abstract

Introduction. Congenital diaphragmatic hernia (CDH) - a relatively rare developmental defect due to a failure of pleuroperitoneal canal closure. The size of the defect between abdominal and thoracic cavities may be variable and it may have a significant impact on the clinical manifestation and prognosis. In this study we set out additional factors to determine if they affect the outcome of the newborns with CDH. Aim of the Study. To investigate and analyze the influence of selected postnatal prognostic factors for predicting the outcome. The primary outcome measure was survival. Material and methods. The present study is retrospective including the data collection and analysis of medical documentation of patients born with CDH and treated in the Children’s Clinical University hospital between 2012 and 2017. The selected prognostic factors included antenatal diagnostics, Apgar score at 1' and 5', need for an early intubation (≤ 3 h after birth), initial blood gases in first 24 h of life, time interval between delivery and surgical therapy, the stomach and liver presence in the thorax, additional congenital abnormalities, a type and duration of invasive ventilatory support. Outcome parameters were compared between survivors (S) and non-survivors (NS). Results. 19 patients (pts) were identified - 14 S and 5 NS. Total mortality rate - 26%. 17/19 had left-sided, 2/19 - right-sided CDH. 17/19 pregnancies were monitored, prenatal diagnosis was made in 8 pts - 3 of them NS. The mean Apgar score at 1’ in S group was 5,5, NS - 5,0. At 5’ - 6,7 and 5,6. Need for an early intubation was 64% for S, 100% - NS. Initial blood gases in S (n=11) and NS (n=5) showed the mean pH value of 7,18 and 7,02. Mean PaCO2 - 62,92 and 77,42 mm Hg. 16/19 underwent the operation. 2 pts died before and 3 after surgical therapy. The average time interval between delivery and surgical therapy in S group was 31,6 hours, NS - 73,7 h. The intrathoracic liver was observed in 3 pts, 2 of them died, the intrathoracic stomach - 2, none of them died. 14/16 pts had a primary surgical repair (PR), 2/16 - Silo closure before total repair. 6 pts had additional congenital defects - 2/14 S and 4/5 NS. 5 out of all 6 had cardiac anomalies. The average required conventional ventilation time in S (n=9) was 175,9 h, NS (n=3) - 25,7 h. High-frequency oscillatory ventilation for S (n=6) was applied for 255 h, NS (n=5) 157,3 h. The results showed statistically significant relationship between the outcome and additional abnormalities (r(17)=.623, p=0.017) and time interval between delivery and surgical therapy (r(11)=.768, p=.014). Conclusions. The possible predictors of outcome were additional abnormalities and time interval between delivery and surgical therapy.