Antenatally diagnosed congenital diaphragmatic hernia in Singapore: a five-year series

Abstract

O r i g i n a l A r tic le 432 I NTRO D U C TIO NCongenital diaphragmatic hernia (CDH), a rare malformation with an incidence of 1.7-5.7 per 10,000 live births, remains one of the most fatal causes of severe respiratory failure.(1,2) CDH was first described by Riveriusin 1672, (3) with the types of defects classified by Morgagni in 1769.(4) The posterolateral defect that we now know as the most common type of CDH was described by Bochdalek in 1848. M E TH O DSAll CDH cases diagnosed antenatally in KKH between January 2006 and December 2010 were obtained using the discharge summary codes and retrospectively reviewed.Population denominators were obtained from KKH's perinatal statistics database. The incidences were calculated according to the format used by the National Birth Defects Registry.Detailed information was collected from the maternal medical records, which included demographic characteristics such as gestational age at diagnosis, method of diagnosis, ultrasonographic findings, prognostication factors (e.g. LHR,FLV and MPA diameter), presence of other anomalies, followup care (e.g. karyotyping, frequency of follow-up appointments and referral to paediatric surgical service), outcome of

Outcomes of neonatal congenital diaphragmatic hernia in a non-ECMO center in a middle-income country: a retrospective cohort study

“…This is the largest study of CDH patients that we have found in SE Asia. Other smaller SE Asian studies have shown survival of patients ranging from 52-79% [8,[19][20][21][22]. Two of these non-ECMO centers in Taiwan and Singapore, which are high-income countries, report survival to hospital discharge rates of 79% [8,20].…”

“…However, results from these studies could be biased by small numbers of liveborn neonates (n = 24 for both) and may reflect differing antenatal detection rates, termination rates, associated birth anomalies, ease of access to tertiary care facilities, and clinical management. Another study from Singapore found that 46% of cases diagnosed antenatally underwent termination [22]; this may in turn lead to improved survival rates of liveborn neonates with CDH. It is not surprising that of the 52 neonates diagnosed antenatally and referred to our hospital for counselling, none underwent termination.…”

“…Over the past two decades, studies from South and Southeast (SE) Asian countries, mostly involving relatively small numbers of neonates and with varying selection criteria, report survival rates ranging from 56-78% in India [14][15][16][17][18], 52% in Malaysia [19], and 56-79% in Taiwan [20,21] and Singapore [8,22], moving from low-middle, upper-middle, and high-income countries, respectively. Antenatal diagnosis varies between 5-79% in these studies and risk factors for non-survival include an antenatal diagnosis, low Apgar score, the presence of moderate-to-severe persistent pulmonary hypertension of the newborn (PPHN), pneumothorax, and high oxygenation index (OI).…”

Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report

“…The maternal and foetal mortality rate from acute pancreatitis during pregnancy was reported to be 20%-50%[ 1 ]. The mortality rate from diaphragmatic hernia during pregnancy was 40%[ 2 ]. There have been case reports of congenital Bochdalek hernia and mild acute pancreatitis during pregnancy; however, to our knowledge, there has been only a single case report of congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy[ 3 ].…”