Early Clinical Outcomes of Congenital Diaphragmatic Hernia and Prognosis: A Retrospective Multicenter Study

Abstract

Objective:Investigation of possible prognostic factors affecting survival in the congenital diaphragmatic hernia.Method:We included all congenital diaphragmatic hernia-diagnosed patients treated in neonatal intensive care units of two centers between 2016 and 2020. We recorded antenatal and birth histories, anthropometric measurements, and clinical features of the hernia. We assessed visceral herniation to the hemithorax, pneumothorax, severely decreased fetal lung volume (<15%), the need for emergency intervention due to pneumothorax in the operating/delivery room, and pulmonary hypertension effects on the survival status. We recorded the data retrospectively.Results:We enrolled 31 patients in the study. The clinical conditions associated with high mortality were pulmonary hypertension (p=0.006), pneumothorax (p=0.009), severely decreased fetal lung volume (<15%) (p<0.001), hepatic (p=0.024) and gastric (p=0.029) herniations to the thorax. In a binomial regression model, PTX and hypoplastic lung were the most significant confounders (R2 McF: 0.858, p<0.001). 19.4% of patients needed emergency intervention in the operating/delivery room. There was no statistically significant difference between deceased and alive patients in terms of postnatal day of surgery.Conclusion:Operation time did not statistically affect mortality. Pneumothorax, severely decreased fetal lung volume, hepatic herniation, gastric herniation, and pulmonary hypertension statistically declined survival. PTX and hypoplastic lung were the most significant confounders.

Keywords

• congenital diaphragmatic hernia
• pneumothorax
• pulmonary hypertension