Author/Authors :
Khaleghnejad-Tabari Ahmad نويسنده , Mahdavi Alireza نويسنده , Mohajerzadeh Leily نويسنده Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran , Fallahi Minoo نويسنده Neonatal Health Research Center (NHRC), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran , Azma Roxana نويسنده Department of Pediatric Radiology, Shahid Beheshti
University of Medical Sciences, Mofid Children’s Hospital, Tehran,
Iran , KAZEMIAN Mohammad نويسنده Neonatal Health Research Center (NHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran , Borhani Samira نويسنده Neonatal Health Research Center (NHRC), Shahid Beheshti
University of Medical Sciences, Tehran, Iran , Roozroukh Mohsen نويسنده Pediatric Surgery Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Abstract :
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.
