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. 2019 Jul-Sep;24(3):176-179.
doi: 10.4103/jiaps.JIAPS_47_18.

Analysis of Prognostic Factors in Congenital Diaphragmatic Hernia in Neonates

Jenisha Chaudhary  1 , B Shivprasad  1 , V Lakshmi  1 , R Shanmughsundaram  1 , G Nandhini  2 , P Balamourougane  2
Affiliations

Analysis of Prognostic Factors in Congenital Diaphragmatic Hernia in Neonates

Jenisha Chaudhary et al. J Indian Assoc Pediatr Surg. 2019 Jul-Sep.

Abstract

Aim: The aim is to study the demographic characteristics of neonates with congenital diaphragmatic hernia (CDH) and to analyze the prognostic factors determining mortality.

Settings and design: A retrospective cohort of CDH admitted at a tertiary level hospital during January 2005-December 2017.

Materials and methods: All cases of CDH admitted to our tertiary care neonatal intensive care unit before undergoing surgery were included in the study. Babies admitted after surgery and those with eventration of the diaphragm were excluded from the study.

Results: Thirty cases (66.66% males, 53.33% inborn, and 63.3% >37 weeks) formed the study cohort. Mean birth weight was 2762 ± 579.67 g and mean gestational age was 37.12 ± 1.76 weeks. About 56.66% of the cases were detected antenatally. The survival rate was 60%. Predictors of poor survival included herniation of the liver or stomach (P < 0.05), low Apgar score at 5 min (<5), presence of moderate-to-severe persistent pulmonary hypertension of the newborn (PPHN) (P < 0.001), presence of shock (P < 0.003), low partial pressure of oxygen, high alveolar-arterial oxygen gradient, and high oxygenation index during first 24 h.

Conclusions: Majority of the neonates with CDH at our center were >37 weeks and survival was 60%. The predictors of adverse outcome were low Apgar score, presence of moderate-to-severe PPHN, need for higher ventilatory settings, and shock. Antenatal detection of diaphragmatic hernia did not impact survival rates.

Keywords: Congenital diaphragmatic hernia; neonates; prognostic factors.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The mean AaDO2 in first 24 hours of admission was significantly higher in non survivor group
Figure 2
Figure 2
The mean Oxygenation index within first 24 hours was significantly higher in non survivors
Figure 3
Figure 3
Survival analysis showing most of the babies expired within 10 days of admission
See this image and copyright information in PMC

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