Outcomes of Congenital Diaphragmatic Hernia: An 8-Year Experience

Background: Congenital diaphragmatic hernia (CDH) is a common congenital anomaly with significant morbidity and mortality. Few surveys have been reported regarding the prenatal status, clinical course and postnatal outcome of CDH. The symptoms and prognosis depend on the location of the defect and associated anomalies.
Objectives: The aim of this study was to examine the effect of clinical factors on the prognosis of CDH in our pediatric hospital.
Methods: We analyzed 74 records of CDH neonates referred to our center for surgery between 2008 and 2015. We investigated the associated factors with the outcomes of CDH using the information extracted from the hospital records. The perinatal status, clinical course and the postnatal outcome were reviewed. Survival was defined as infants alive at hospital discharge.
Results: A total of 74 CDH cases were identified. Of these, 27 (36.5%) cases were females and 47 (63.5%) males. The type of hernia in 73 (98.6%) cases was Bochdaleck and 1 (1.4%) case was Morgagni. Seventeen (23.9%) cases had right-sided CDH and 57 (76.1%) cases left- sided CDH. Also, 90.5% underwent open surgery and 9.5% thoracoscopic repair. Forty-seven (63.5%) cases survived and 27 (36.5%) cases succumbed. The survival rate had a significant statistical correlation with the place of delivery. The death rate was higher in neonates referred from other hospitals in our town in comparison to other cities (P = 0.008). Also, the resuscitation history, the status at admission (intubated or not intubated) (P = 0.00), existence of skeletal anomalies (P = 0.02) and brain hemorrhage (P = 0.045) had a significant correlation with the survival rate. The side of herniation, herniated organs, type of operation (open or thoracoscopic), cardiac and renal anomalies and age at the time of surgery had no significant correlation with outcome.
Conclusions: The overall mortality rate in CDH was high in our series. Neonates with CDH should be delivered in institutes with the neonatal intensive care unit and surgery ward to prevent complications. To achieve better survival rates, pulmonary hypertension should intensively be controlled and the extracorporeal membrane oxygenation should be used in selected cases.

Keywords
Congenital Diaphragmatic Hernia; Congenital Anomaly; Neonate; Bochdaleck Hernia