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Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource
Auwal M Abubakar1, Mustapha A Bello, John Y Chinda
1Department of Surgery, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria. walolng@yahoo.co.uk
Insights
Congenital diaphragmatic hernia (CDH) management is challenging in resource-poor settings. Early-presenting CDH has a poor prognosis, while late-presenting cases can be successfully treated with timely intervention.
Area of Science:
- Pediatric Surgery
- Neonatology
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) remains a significant surgical challenge.
- Limited resources and facilities exacerbate CDH management difficulties.
- This study focuses on the unique aspects of CDH care in resource-limited environments.
Purpose of the Study:
- To describe the specific challenges and outcomes of congenital diaphragmatic hernia (CDH) management.
- To highlight the peculiarities of CDH treatment in a low-resource setting.
- To inform diagnostic and treatment strategies for CDH.
Main Methods:
- Prospective documentation of all confirmed congenital diaphragmatic hernia (CDH) cases.
- Data collection from 2003 to the present.
- Analysis of patient demographics, defect laterality, surgical approach, and outcomes.
Main Results:
- Seven children with CDH were treated.
- Left-sided defects (83.8%) were more common than right-sided (17.7%).
- All patients underwent primary abdominal closure without a patch; early-presenting cases had a high mortality rate (3/3 died), while late-presenting cases had a better survival rate (4/4 survived).
Conclusions:
- Severe, early-presenting CDH has a poor prognosis in settings with inadequate neonatal intensive care.
- Late-presenting CDH presents diagnostic challenges but offers an excellent prognosis with appropriate treatment.
- Physicians should consider CDH in the differential diagnosis for birth asphyxia and chronic respiratory symptoms with failure to thrive.
Background:
Despite the advances in management, congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting.
Methods:
All confirmed cases of CDH were prospectively documented from 2003 till date.
Results:
Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8%) and on the right side in one (17.7%). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived.
Conclusion:
With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.
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