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Analysis of Prognostic Factors in Congenital Diaphragmatic Hernia in Neonates
Jenisha Chaudhary1, B Shivprasad1, V Lakshmi1
1Department of Neonatology, Mehta Children Hospital, Chennai, Tamil Nadu, India.
Aim:
The aim is to study the demographic characteristics of neonates with congenital diaphragmatic hernia (CDH) and to analyze the prognostic factors determining mortality.
Settings And Design:
A retrospective cohort of CDH admitted at a tertiary level hospital during January 2005-December 2017.
Materials And Methods:
All cases of CDH admitted to our tertiary care neonatal intensive care unit before undergoing surgery were included in the study. Babies admitted after surgery and those with eventration of the diaphragm were excluded from the study.
Results:
Thirty cases (66.66% males, 53.33% inborn, and 63.3% >37 weeks) formed the study cohort. Mean birth weight was 2762 ± 579.67 g and mean gestational age was 37.12 ± 1.76 weeks. About 56.66% of the cases were detected antenatally. The survival rate was 60%. Predictors of poor survival included herniation of the liver or stomach (P < 0.05), low Apgar score at 5 min (<5), presence of moderate-to-severe persistent pulmonary hypertension of the newborn (PPHN) (P < 0.001), presence of shock (P < 0.003), low partial pressure of oxygen, high alveolar-arterial oxygen gradient, and high oxygenation index during first 24 h.
Conclusions:
Majority of the neonates with CDH at our center were >37 weeks and survival was 60%. The predictors of adverse outcome were low Apgar score, presence of moderate-to-severe PPHN, need for higher ventilatory settings, and shock. Antenatal detection of diaphragmatic hernia did not impact survival rates.
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