Congenital Diaphragmatic Hernia With Poor Clinical Outcome: Key Lessons To Be Learned

Congenital diaphragmatic hernia (CDH) refers to the abnormal protrusion of abdominal contents (stomach, intestine) into the thoracic cavity, leading to the underdevelopment of the lungs (pulmonary hypoplasia). It is a critical neonatal condition that presents significant challenges in both diagnosis and management, especially in resource-limited countries. This case report describes a term female baby born via normal vaginal delivery to a mother with no prenatal care. The baby showed no respiratory effort and required resuscitation. Despite intubation, the baby's air entry remained poor, and she was transferred to the NICU. Initial blood gas analysis revealed severe respiratory and metabolic acidosis (pH: 6.8, pCO2: 86), indicating significant respiratory compromise. A chest X-ray confirmed the diagnosis of right-sided CDH, accompanied by left-sided pneumothorax, hypoplastic lungs, and a compressed heart. The patient was stabilized in the NICU with high-frequency ventilation and was subsequently transferred to a referral center with a Level IV NICU, where she was kept on high intermittent positive pressure ventilation (IPPV). Ultimately, the neonate did not survive the postoperative period, succumbing to the severe complications associated with her condition. This case report discusses the presentation, management, and outcomes of a female neonate born with CDH, requiring immediate intervention. Despite aggressive resuscitation efforts and surgical repair, the neonate succumbed to severe complications. This case underscores the importance of early detection, prompt treatment, and the complexities involved in managing CDH, particularly in resource-limited settings.