Congenital diaphragmatic hernia: short-term outcome.
BACKGROUND
Despite progress in medical and surgical care the mortality rate of congenital diaphragmatic hernia remains high. Assessment of short-term outcome is important for comparison between different medical centers.


OBJECTIVE
To evaluate the short-term outcome of infants born with symptomatic CDH and to correlate demographic and clinical parameters with short-term outcome.


METHODS
We performed a retrospective cohort study in which demographic, obstetric and perinatal characteristics were extracted from infants' files. For comparison of categorical variables chi-square test and Fisher's exact test were used and for comparison of continuous variables with categorical variables the Mann-Whitney test was used. Sensitivity and specificity were estimated by receiver operator curve.


RESULTS
The study group comprised 54 infants with CDH, of whom 20 (37%) survived the neonatal period. Demographic characteristics were not associated with survival. Regarding antenatal characteristics, absence of polyhydramnion and postnatal diagnosis were correlated with better survival. Apgar scores (above 5 at 1 minute and 7 at 5 minutes), first arterial pH after delivery (above 7.135) and presence of pulmonary hypertension were significantly correlated with survival. Also, infants surviving up to 6 days were 10.71 times more likely to survive the neonatal period.


CONCLUSIONS
The survival rate of symptomatic newborns with CDH at our center was 37% for the period 1988-2006. Prenatal diagnosis, Apgar score at 5 minutes and first pH after delivery were found to be the most significant predictors of survival. Prospective work is needed to evaluate the long-term outcome of infants with CDH.
Cohen-Katan
Shlomo
S
Faculty of Health Sciences, Department of Ben-Gurion University of the Negev, Beer Sheva, Israel.
Newman-Heiman
Nitza
N
Staretz-Chacham
Orna
O
Cohen
Zahavi
Z
Neumann
Lily
L
Shany
Eilon
E
D000015:Abnormalities, Multiple / Q000401:mortality; D001034:Apgar Score; D015331:Cohort Studies; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome