Analysis of prognostic factors in congenital diaphragmatic hernia in neonates

Abstract

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.

Liver pathological alterations in fetal rabbit model of congenital diaphragmatic hernia

“…It is a useful prenatal prognostic factor when associated with other markers, including intrathoracic stomach, lung-to-head ratio (LHR), observed to expected LHR, percentage predicted lung volumes, and total lung volume. The link between liver herniation and a poor prognosis in CDH has been described, [5][6][7][8][9][10][11][12]19 but has yet to be fully elucidated and the hypothesis of the involvement of structural liver anomalies other than liver protrusion into the thoracic cavity has also been proposed. 13 Altered morphological and cellular liver development, together with hepatic hypertrophy and increased cell apoptosis, have been described in the experimental induced CDH rat model.…”

Distributed Big Data Analytics Method for the Early Prediction of the Neonatal 5-Minute Apgar Score before or during Birth and Ranking the Risk Factors from a National Dataset

“…Another study performed a retrospective, cohort study of 58,429 term singleton birth cases at a hospital in Australia in 2007-2013 to find important variables discriminating low (≤3) or moderate (4)(5)(6) and high (≥7) 5-min Apgar scores [13].…”

“…An Apgar score of 7 or higher shows that the newborn has good to excellent health situations. Low Apgar scores at 5 min after birth have been diagnosed as an important risk factor poor survival for neonates [3], birth asphyxia [4] and ADHD [5].…”

Comparison of the incidence of intrathoracic stomach in Bochdalek's hernia detected by imaging with that detected by surgery

“…Herniation within the leftsided BH usually involve empty viscera, such as the small intestine, colon or stomach.And it may also involve the spleen, left lobe of the liver, or left kidney [7,8] . The position of the stomach is an important indicator of the prognosis of left CDH [9] ,gastric hernia into the thoracic cavity often indicates a large diaphragm defect, and may have high mortality and poor prognosis [10][11][12] .In particular, the position of the stomach may affect the surgical method and recurrence rates [13,14] .…”