Evaluation of congenital diaphragmatic hernia in a tertiary health center of a developing country: management and survival.
OBJECTIVE
The purpose was to evaluate the diagnosis and efficacy of management of congenital diaphragmatic hernia (CDH) in a tertiary health center of a developing country.


METHODS
Forty-six children aged from 1 day to 7 years were studied. Parameters studied were age, sex, clinical features, and management.


RESULTS
Fifty-six percent of patients presented in the neonatal period; however, none of them presented on the first day of life. The majority (91.3%) of patients had left-sided CDH. Respiratory distress was the most common clinical feature observed (91.3%). Chest X-ray confirmed the diagnosis in 82.6% of patients, and contrast study was needed in the remaining 17.4%. The survival rate was 87%. It was better in patients presenting late than those presenting in the early neonatal period. Stabilization in the preoperative period improved survival. Not using a chest tube had no adverse effect on survival.


CONCLUSIONS
The relatively increased survival rate of CDH in a tertiary health center of a developing country is attributed to delayed arrival to the center. Respiratory infections compound the survival. More studies are needed before it can be safely said that not using a chest tube has no adverse outcome. Late presentation has been associated with varied manifestations, hence proper clinical evaluation, a high index of suspicion and adequate management, which includes imaging and surgery after stabilization, gives excellent results.
Pandey
A
A
Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India. dranand27@rediffmail.com
Tandon
R K
RK
Kureel
S N
SN
Wakhlu
A
A
Rawat
J
J
D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D015996:Survival Rate