Correlation between findings on chest radiography and survival in neonates with congenital diaphragmatic hernia

Predictors of survival are helpful when deciding on aggressiveness of care of neonates with congenital diaphragmatic hernia and respiratory failure. We evaluated findings on chest radiography as potential predictors of survival in these patients.

Findings on chest radiographs of neonates less than 24 hr old with congenital diaphragmatic hernia were evaluated. Radiographic findings analyzed included percentage of aerated ipsilateral lung, percentage of aerated contralateral lung, mediastinal shift, and hernia contents. Each finding was compared with survival (equated with hospital discharge) using a Mantel-Haenszel chi-square test. Survival was also determined using the total number of poor prognostic findings present in any one patient.

In the 73 neonates with congenital diaphragmatic hernia in our study, the overall survival rate was 55%. There were statistically significant relationships between survival rate and percentage of ipsilateral aeration (p = 0.001), percentage of contralateral aeration (p = 0.016), and mediastinal shift (p = 0.026). The survival rate for multiple poor prognostic factors was 0% with four of four factors and 20% with three of four factors (p = 0.001). Survival rate was not influenced by prematurity (p = 0.102), sex (p = 0.104), or side of hernia (p = 0.895).

Findings on initial chest radiography are helpful in predicting survival in neonates with congenital diaphragmatic hernia.