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Improving Trends in the Outcome of Live Inborn Babies with Congenital Diaphragmatic Hernia following development of a Centralised Management Protocol

Presented at the Neonatal Society 2015 Spring Meeting.

Kumar R1, Shenvi A2, Bedford-Russell A1, Ewer AK1, Rasiah SV1

1 Birmingham Women’s NHS Foundation Trust Hospital
2 University Hospital of North Midlands

Background: The incidence of congenital diaphragmatic hernia (CDH) is 1:2500 live births. In accordance with findings from the MBRRACE-UK CDH report (1), significant variations in practice were associated with high mortality. Since 2010, care has been centralised within two West Midlands Newborn Networks. All antenatally detected cases of CDH are referred to the regional perinatal centre for fetal medicine assessment, surgical and neonatal counselling. Babies are managed postnatally using agreed guidelines developed by surgical, PICU and neonatal teams. 

Methods: Our aim was to review the outcomes of all inborn and live-born babies with CDH, in a regional neonatal intensive care unit (NICU) between January 2000 and December 2014 (15 years), following the implementation of a regional care pathway. All live-born babies with CDH were identified using the clinical diagnosis code and Badger electronic records. A retrospective review of the patient’s clinical case notes was then done.

Results: The table below summarises the outcomes over five year epochs, the centralised management protocol was implemented in 2010 and the overall survival for 2014 was 73%.

Improving Trends in the Outcome of Live Inborn Babies with Congenital Diaphragmatic Hernia following development of a Centralised Management Protocol

Conclusion: Centralised management of CDH resulted in all antenatally diagnosed babies being delivered in the regional NICU and reduced variation in postnatal management. There is an improving trend in survival; however benefits have taken 4 years to be realised. ECMO referral has increased. Postsurgical survival without ECMO is excellent. These figures provide important information when counselling parents antenatally.

Corresponding author: rohit.kumar@bwnft.nhs.uk

References
1. MBRRACE-UK Perinatal Confidential Enquiry Congenital Diaphragmatic Hernia Report 2014

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