Congenital diaphragmatic hernia in a developing country

Bhat YR, Kumar V, Rao A
Correspondence: Dr Ramesh Bhat Y, docrameshbhat@yahoo.co.in

ABSTRACT
Introduction Outcome of neonates with congenital diaphragmatic hernia (CDH) varies widely and the data from developing countries is scanty. We aimed to study the management and outcome of CDH. We also aimed to ascertain prenatal and postnatal factors affecting the outcome.
Methods A retrospective review of neonates with CDH admitted to a teaching hospital was conducted. Demographical data, prenatal and postnatal factors, birth details, management and outcomes were studied. Survival was the primary outcome.
Results 16 live-born neonates with diaphragmatic hernia were admitted during the study period. All neonates had hernia on the left side. Mean (standard deviation) gestational age and birth weight were 38.6 (1.5) weeks and 2,616.6 (457) g, respectively. Polyhydramnios was associated in one patient, and additional anomalies in five patients (31.3 percent). Overall survival was 56.3 percent. The CDH was detected prenatally in four and postnatally in 12 patients. 12 neonates underwent surgery and nine survived. Prenatally-detected cases had significantly reduced survival to surgery, overall survival and lower Apgar scores at one minute (p-value is less than 0.04). Median age at surgery was 48 hours. Average duration of mechanical ventilation among survivors was 91.5 hours. Neonatal intensive care unit stay ranged from five to 27 (median nine) days. Six of seven deaths occurred within 72 hours of life. Non-survivors had significantly low Apgar scores and were symptomatic within 12 hours of life (p-value is less than 0.03).
Conclusion Greater than 50 percent survival of neonates with CDH was observed in a centre with conventional ventilation. Poor outcome is likely in neonates who present within 12 hours of life.

Keywords: congenital diaphragmatic hernia, neonatal hernia, neonatal survival
Singapore Med J. 2008; 49(9): 715-8