Early outcome of congenital diaphragmatic hernia in a Malaysian tertiary centre.
BACKGROUND
This prospective observational study was conducted to determine the outcome of newborns with congenital diaphragmatic hernia (CDH). They were managed with a protocol of gentle ventilation to avoid barotraumas, and inhaled nitric oxide (iNO) or intravenous magnesium sulphate for treatment of persistent pulmonary hypertension of newborns (PPHN).


METHODS
All newborns with CDH admitted to neonatal intensive care unit of this hospital during the six-year study period were recruited. High frequency oscillatory ventilation was used when infants required peak inspiratory pressure of more than 25 mmHg. iNO at 20 ppm or intravenous magnesium sulphate was used when PPHN developed. Arterial blood pH was maintained between 7.35 and 7.45, and partial pressure of arterial carbon dioxide was kept above 35 mmHg. Surgery was performed when the infants' general condition and blood gases were stabilised for at least 24 hours.


RESULTS
Of 21 infants recruited (15 males and six females, median gestational age 39.0 weeks, median birth weight 2,800 grams), 52.4 percent had PPHN. 12 (57.1 percent) underwent surgery at a median age of 4.9 days. One died postoperatively due to PPHN. Out of the 21 subjects, 11 (52.4 percent) survived to discharge. There was no significant difference in the demographic characteristics, side and size of CDH defects, presence of PPHN, or type of treatment received, between infants who survived and died. However, infants who died had significantly lower mean Apgar scores at five minutes of life (p-value is 0.02), and higher mean oxygenation indexes (OI) (p-value is 0.01) than those of survivors. Two (18.2 percent) of the 11 survivors developed chronic lung disease.


CONCLUSIONS
Low Apgar scores and high OI were associated with poor outcome in infants with CDH.
Rohana
J
J
Department of Paediatrics, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia. drohana@mail.hukm.ukm.my
Boo
N Y
NY
Thambidorai
C R
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D000280:Administration, Inhalation; D001034:Apgar Score; D003131:Combined Modality Therapy; D003906:Developing Countries; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D006612:High-Frequency Ventilation; D006785:Hospitals, University; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D007226:Infant Mortality; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007363:Intensive Care Units, Neonatal; D008278:Magnesium Sulfate / Q000008:administration & dosage; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D009569:Nitric Oxide; D008278:Magnesium Sulfate