Prognosis of congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) contributes significantly to perinatal morbidity and mortality. This retrospective study examines the experience of a major teaching hospital to establish survival rates and factors influencing outcome. Survival rates were found to relate closely to the stage at which the diagnosis was made and the presence of associated anomalies. Ultrasound diagnosis early in pregnancy is associated with a higher mortality rate than diagnosis made late in pregnancy or after delivery. Logistic regression analysis and chi-squared analysis did not establish to a significant degree that any factor, alone or in combination, was a reliable prognostic indicator. It is acknowledged, however, that figures in this series are small. Survival figures are presented to facilitate reliable parental counselling. In particular, the presence of associated major anomalies and the gestational age at which diagnosis is made are of critical importance in accurately counselling parents regarding the prognosis for survival. In this study, excluding terminations, the mortality rate for isolated CDH diagnosis before the 21st week was 45.5%, with a corresponding survival rate of 54.5%. Once the infant was liveborn, however, the survival rate rose to 68.0%, and if the infant survived transfer to a paediatric surgical unit, the survival rate in this study was 73.9 %.