Congenital diaphragmatic hernia: a critical analysis of 5 years experience-predictors of mortality
Dhir, Retika; Soni, Arun; Garg, Pankaj; Saluja, Satish and Kler, Neelam (2002) Congenital diaphragmatic hernia: a critical analysis of 5 years experience-predictors of mortality. In: The 22nd Annual Convention of National Neonatology Forum, 2002, Delhi, India.
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Introduction: Congenital Diaphragmatic Hernia (CDH), occurring approximately in 1 in 2000 to 1 in 10,000 live births, remains a significant cause of perinatal death and morbidity despite current therapeutic advances. An increasing percentage of CDH are now diagnosed antenatally by ultrasonography. Antenatal diagnosis allows evaluation of the fetus for approaches and prognosis. It is still not yet well understood as to what factors are most accurate for predicating eventual outcome. Aims and Objectives: The aim of the study was to investigate the influence of perinatal factors as well as other predictors of morality. Materials and Methods: A retrospective unicentric analysis of babies admitted with a diagnosis of congenital diaphragmatic hernia at the Neonatal intensive Care Unit. Sir Ganga Ram Hospital, New Delhi was conducted over a period of 5 years. Inborn babies as well as babies referred with the antenatal diagnosis of CDH or those diagnosed at birth and then referred were included. These babies were analysed for gestational age, birth weight, Apgar Score, age at onset of symptoms, associated anomalies, preoperative arterial blood gases and clinical signs of persistent pulmonary hypertension. Results: During this 5 year period, 31 neonates with CDH were admitted in the NICU. The incidence of CDH in our institute was 0.69% of the NICU admissions and 4 per 2600 intramural live births. Of the total 31 neonates with CDH included in the study, 26 were outborn who were referred after diagnosis of CDH was made. 20 (64.5%) babies of the total were antenatally diagnosed of which 9 were diagnosed at gestational age <24 weeks. 19 (61.3%) were complicated by polyhydramios and 23 (74.1%) underwent elective LSCS. Most of the babies had onset of respiratory distress within 2hrs of birth except for 2 who presented after 6 hrs. Babies were taken up for early surgery after initial resuscitation in the NICU. The average time of surgery was 2-16 hrs. (inborn mean time- 3.4 hrs outborn - 9.2 hrs.). Overall mortality rate was 54.8% (17/31) of which two-thirds (64.7%) were outborn babies.
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