Right-sided congenital diaphragmatic hernia: A tertiary centre's experience over 25 years

Abstract

AIMS: To provide analysis on infants treated for right-sided congenital diaphragmatic hernia (RCDH) including mortality, neonatal morbidities, and associated congenital anomalies. METHODS:We reviewed records of infants admitted with RCDH from 1985 to 2010. RESULTS: A total of 160 infants with CDH were identified; of them 22 infants had RCDH, 14 (64%) were male and eight (36%) were female. Eleven of the 22 infants died (50%), of which seven (64%) were male, and four (36%) were female. Three infants (13.6 %) were diagnosed prenatally, and 19 (86.4%) were diagnosed postnatally. A statistically significant association with mortality was observed for low five minute Apgar score (OR = 8; 95% CI: 1.24-51.5), and high alveolar-arterial gradient >400 (OR = 25.7; 95% CI: 2.2-298.5). Fourteen infants (64%) underwent surgical correction, three (21.4%) infants who underwent surgery died. Three infants were discharged with oxygen supplementation and tube feeding at home, and one on sildenafil. No statistical significance was observed between other variables and mortality/morbidity. We observed a change in practice in relation to timing of surgery allowing stabilisation of patient prior to surgery. Average in-patient stay for RCDH infants was 23.5 days (range: 0-112), compared with the total in-patient mean stay of 10.5 days. CONCLUSIONS: Low five minute Apgar score, and high alveolar-arterial gradient were significant predictors of mortality. RCDH is associated with high mortality (50%), prolonged length of stay and other anomalies. In recent years, we observed an improving trend for survival.

Management of right posterolateral congenital diaphragmatic hernia in a resource-limited country. case report and review

“…This respiratory distress associated with decreased respiratory sounds on the side homolateral to the hernia, a retracted abdomen and a shift in heart sounds to the contralateral side are key diagnostic symptoms. 23 The thoracoabdominal X-ray at birth shows digestive clearing in the thorax, as on our patient's X-ray, and a mediastinal shift. [24][25][26][27] These signs in our patient led to the diagnosis.…”

“…2,11,22 According to Jani et al, this difficulty is increased prenatally by ultrasound in cases where the liver is the only organ to have herniated, due to its echogenicity similar to that of the lungs. 23 However, Hedrick et al in Philadelphia were able to make the diagnosis prenatally in 81.5% of cases. 22 In the absence of prenatal diagnosis, neonatal respiratory distress remains the key symptom of this pathology at birth, as presented by the present patient.…”