Aim of the Study:
This study evaluates the outcomes of neonates treated for congenital diaphragmatic hernia (CDH) at our centre over an 18-year period.
Method:
A retrospective case note review of neonates with CDH, admitted between January 2006 and December 2024. Demographic and outcome data were collected: survival, recurrence, complications, surgical approaches, and factors influencing prognosis. Analysis was conducted using the JASP application, and significance was assessed using Chi-Squared (p-values <0.05 were considered significant). Data are presented as median [interquartile range (IQR)].
Results:
Ninety-four neonates were identified, of whom 77 were left-sided CDH, 73 survived to operation, and the overall survival was 74%. Following surgery, right-sided CDH was associated with a higher incidence of needing a patch (40%) and a higher mortality (30%). The figures for left CDH were 7.9% and 0%, respectively. Recurrence was recorded to be in four (6.3%) left-sided CDHs and one (10%) right-sided CDH.
Factors negatively impacting survival included pulmonary hypertension, inhaled nitric oxide (50% mortality, p<0.001), and high-frequency oscillatory ventilation (63% mortality, p<0.001). A preoperative oxygenation index greater than seven was associated with mortality (p = 0.002). Long-term complications included gastroesophageal reflux (14%), chronic lung disease (1%), and long-term pulmonary hypertension (1%).
Conclusion:
CDH repair in a moderate-volume centre is associated with acceptable outcomes for operated patients. Neonates requiring advanced ventilation strategies, including Nitric oxide, high-frequency oscillatory ventilation, and inotropes, are associated with worsened survival.
Right-sided CDH was associated with a higher incidence of needing a patch and a higher mortality. Further optimisation of management protocols and long-term follow-up is essential.
Keywords: congenital diaphragmatic hernia, repair, survival, recurrence, pulmonary hypertension.
Anahtar Kelimeler: