Factors affecting outcome in neonates with congenital diaphragmatic hernia at tertiary care center

Abstract

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a major congenital anomaly requiring surgical intervention after birth. Due to improvements in antenatal diagnosis and perinatal management with well advanced neonatal intensive care, there are better overall survival rates in the developed countries. However, the outcome is still poor in developing countries where multiple factors contribute to higher morbidity and mortality. AIM: The aim of the study is to evaluate various factors affecting the perioperative management and their outcome in neonates with CDH. MATERIALS AND METHODS: This descriptive observational study was conducted over a period of 4 years. Neonates who underwent surgery for CDH were included. Demographic data, clinical data, gender, birth weight, period of gestation, antenatal diagnosis records, additional congenital anomalies, initial blood gases in the first 24 h of life, stomach or liver herniation in the thorax, postoperative complications, and final outcome were recorded. RESULTS: During our study period, 36 neonates underwent surgery for CDH. Associated anomalies were detected in 47.2% cases. Persistent pulmonary hypertension was seen in 44.4% cases. Sepsis (55.5%) was the most common complication. Mortality in our study was 64%. Persistent pulmonary hypertension (93.75%) was the most common factor associated with mortality followed by sepsis (80%). Antenatal diagnosis before 20 weeks had the highest mortality (85.7%). Liver or stomach as a thoracic content in diaphragmatic hernia had high mortality. CONCLUSION: Sepsis, shock, hypothermia, metabolic acidosis, and pneumonitis were the preventable factors affecting outcome in CDH. Improving pediatric surgical facilities and neonatal care can improve survival in developing countries.

Keywords

• anomalies
• congenital diaphragmatic hernia
• lung hypoplasia
• mortality
• pulmonary hypertension