The Role of Predictors Parameters in the Management Policy and Outcome of Congenital Diaphragmatic Hernia with the Lack of Resources in Single Pediatric Surgery Unit

Abstract

Abstract:Background: The objective of this study is to have the interest to know how far the present study underscores the improved survival rate for patients with CDH and risk factors affecting the outcome with the lack of many essential facilities. Our inquiries: shall we proceed without ECMO and related resources! Patients and Methods: The records of patients admitted with CDH to the pediatric surgery unit at the Maternity and Children Teaching Hospital Al Qadisiya, Iraq, from January 1, 2005, to the end of December 2014 were retrospectively reviewed. Reports obtained about operative findings, respiratory complications, although attempts were made to confirm a suspected diagnosis of pulmonary hypertension using echocardiography. Despite that, the permissive hypercapnia and ECMO were not practiced during the study period (these facilities still unavailable in our unit), we considering that the studied patients suspected to have such facilities according to ECMO protocol. All presentation factors with some of the predictive parameters are studied and taken as background to analyze our study. Statistical analyses performed using the Statistical Package for Social Sciences (SPSS) version 20 software and Excel 2016. Independent t-test used for analysis of normally distributed continuous data. A p-value of <.0001 considered statistically significant. Results: Thirty-one patients (26 neonates) were managed at our unit with an overall survival 19 of the total patients 73.07% and 14 (53.84%) of the neonates. Male presented 18 (69.23%) out of the total. Birth weight in grams (range) 3100 (2100 to 4390). Apgar (mean) at 5 min. after delivery (range) 6.2±2.1. At the level of Prenatal factors, chest to head circumference ratio <0.80 presented as the most important risk factor (Odd ratio 27.50, 95% confidence intervals (CI) upper 289.13 and p-value <.0001). At birth factors, associated major anomalies (Odd ratio 3.50, 95% CI upper 17.89 and p-value <.0001) formed risk parameter. Overall, both favorable and unfavorable factors had significant correlation and predictive effects on both survival and mortality groups respectively. Conclusion: A composite of prognostic and predictive parameters, however, organize our workup and can magnify our management future policy despite that, these prognostic indicators measure different aspects of CDH.