Postnatal predictors for outcome in congenital diaphragmatic hernia: A singlecenter retrospective cohort study from India

Abstract

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.

A clinical study on congenital diaphragmatic hernia in neonates: Our institutional experience

“…reported 50% mortality for preterm neonates with CDH (<34 weeks or birth weight <2000 g), compared to 27% mortality for neonates >34 weeks. [ 20 21 22 23 24 25 26 ] In this study, we had three cases of neonates with <34 weeks gestational age; all of them survived. Only 1/12 (8.3%) neonates with birth weight of 1900 g (neonates <2000 g group) died at 37 weeks of gestational age preoperatively.…”

“…In our series, lowest weight of a neonate was 1600 g which survived following surgery. [ 20 21 22 23 24 25 26 ]…”

Analysis of prognostic factors in congenital diaphragmatic hernia in neonates

“…Clinical parameters associated with poor prognosis in various studies are low Apgar score at birth, presence of severe PPHN, shock, and need for extracorporeal membrane oxygenation (ECMO). [257] In our study, low Apgar score (<5 at 5 min), presence of moderate-to-severe PPHN, and shock were associated with poor prognosis.…”

“…Studies from other Indian centers have reported survival rate ranging from 58% to 78%. [234] On the other hand, studies from developed countries have reported a survival rate of 85%–90% with protocolized care. [67]…”

“…Similar results were observed by Chandrasekaran et al . [2] Contents of hernia including liver and stomach have been reported to have a poor prognosis. [8910] In the present study also, babies with liver or stomach as the content of hernia were at significantly higher risk of mortality.…”