title: Right-sided congenital diaphragmatic hernia: A tertiary centre's experience over 25 years.
abstract: OBJECTIVE
  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.
authors.affiliation: Grace Centre's for Newborn Care, The Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Jani
authors.affiliation: Department of Surgery, The Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.
authors.forename: S S
authors.initials: SS
authors.lastname: Bidarkar
authors.affiliation: Grace Centre's for Newborn Care, The Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Walker
authors.affiliation: Grace Centre's for Newborn Care, The Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Halliday
authors.affiliation: Grace Centre's for Newborn Care, The Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Badawi
authors.affiliation: Department of Surgery, The Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.
authors.forename: R C
authors.initials: RC
authors.lastname: Cohen
mesh_terms: D001034:Apgar Score; D001315:Australia / Q000453:epidemiology; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis / Q000401:mortality*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011237:Predictive Value of Tests; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers; D016216:Ultrasonography, Prenatal
keywords: Apgar score; Newborn infant; diaphragmatic hernia; outcomes; surgery