Assessment of Antenatal and Postnatal Prognostic Indicators in the Outcome of Neonatal Congenital Diaphragmatic Hernia: A Prospective Observational Study

Aniruthan Deivasigamani; Bikash Kumar Naredi; Bibekanand Jindal; Kumaravel Sambandan; Krishnakumar Govindarajan; Nishad Plakkal; Mamatha Gowda

doi:10.4103/jiaps.jiaps_105_22

Assessment of Antenatal and Postnatal Prognostic Indicators in the Outcome of Neonatal Congenital Diaphragmatic Hernia: A Prospective Observational Study

J Indian Assoc Pediatr Surg. 2023 Mar-Apr;28(2):122-127. doi: 10.4103/jiaps.jiaps_105_22. Epub 2022 Nov 30.

Authors

Aniruthan Deivasigamani¹, Bikash Kumar Naredi¹, Bibekanand Jindal¹, Kumaravel Sambandan¹, Krishnakumar Govindarajan¹, Nishad Plakkal², Mamatha Gowda³

Affiliations

¹ Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
² Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
³ Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Abstract

Context: Despite advances in neonatal intensive care, surgical methods, and anesthesia, congenital diaphragmatic hernia (CDH) is still associated with significant mortality. Predicting which babies will have poorer outcomes is essential to identify the high-risk babies and to give targeted care and accurate prognosis to the parents, especially in a resource crunch set-up.

Aims: The aim of this study is to evaluate the antenatal and postnatal prognostic factors in neonatal CDH that can be used to predict the outcome.

Settings and design: This was a prospective observational study in a tertiary care center.

Subjects and methods: Neonates presented with CDH within 28 days of life were included in the study. Bilateral disease, recurrent diseases, and babies operated outside were excluded from the study. The data were collected prospectively, and babies were followed until discharge or death.

Statistical analysis used: Data were expressed in mean with standard deviation or median with range based on normality. All the data were analyzed using the SPSS software version 25.

Results: Thirty babies with neonatal CDH were studied. There were three right-sided cases. The male-to-female ratio was 2.3:1, and 93% of babies were antenatally diagnosed. Seventeen out of the 30 babies underwent surgery. Nine (52.9%) underwent laparotomy, and 8 (47%) underwent thoracoscopic repair. Overall mortality was 53.3%, and operative mortality was 17.6%. Demographic characteristics were comparable between expired versus survived babies. The significant predictors of outcome identified were - Persistent pulmonary hypertension (PPHN), mesh repair, high-frequency oscillatory ventilation (HFOV), use of inotropes, 5-min APGAR, ventilator index (VI), and HCO3 levels.

Conclusions: We conclude that the prognostic indicators associated with poor prognosis are low 5-min APGAR, high VI, low HCO3 levels in venous blood gas analysis, mesh repair, HFOV, inotropes usage, and PPHN. None of the antenatal factors studied showed any statistical significance. Further prospective studies with a larger sample size are recommended to confirm the findings.

Keywords: Congenital anomaly; congenital diaphragmatic hernia; prognostic indicators.