Congenital diaphragmatic hernia: Update on regional experience

A consecutive series of 34 patients with congenital diaphragmatic hernia are reported from a tertiary neonatal care unit in the Eastern Province. All the patients presented within the first 24 hours of life with left-sided defect. The overall mortality (56%) and postoperatiVE mortality (44%) are comparable with reports from other centers. The outcome of treatment correlated well with the age on presentation, the size of the defect, and preoperative blood gas results. Our approach to management has been modified lately, in the light of recent experience from other centers. The surgery is delayed until the neonate is stabilized with biochemical values of PaCO2 = 45 torr or less; pH = 7.2 or higher; and PaO2 = 50 torr or more. This management policy did not adversely affect overall survival. The problem encountered with patient transfer and the need for continued improvement in the organization of regionalized care are highlighted.