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Outcome of live born infants with congenital diaphragmatic hernia over a 10 year period in a tertiary Neonatal Unit in the West Midlands

Presented at the Neonatal Society 2010 Summer Meeting.

Shenvi A1, Ewer AK1,2, Rasiah SV1

1 Neonatal Intensive Care Unit, Birmingham Women’s Hospital, UK
2 School of Clinical and Experimental Medicine, University of Birmingham

Background: The incidence of congenital diaphragmatic hernia (CDH) is approximately 1 in 3000 with reported survival of 60-70% (1).

Aim: To review the management and outcome of all live born babies with CDH delivered at Birmingham Women’s Hospital from January 2000-December 2009.

Methods: Retrospective case-note review of babies with CDH identified by their clinical diagnosis code. Trust audit department approval was obtained. Data were collected regarding demographics, ventilatory support, inhaled Nitric Oxide, referral for ECMO, PICU and outcome.

Results: 60 liveborn babies with CDH were identified during the study period. 56 babies were diagnosed antenatally. Median gestational age at delivery was 39 weeks (range 33-42 weeks). The median birth weight was 2970g (range 1080-4090g). There were 35 boys (58%). 53 cases were left sided. All babies were actively resuscitated at delivery. 3 babies died in delivery suite despite resuscitation. 18 babies died on the neonatal unit despite full intensive care. 6 were referred for ECMO and 5 of these survived. 33 babies were transferred to PICU but 3 babies died before surgery (1 unknown). 29 babies had surgery and 2 died post-surgery. The 30 day surgical survival rate was 93%. 32 babies are alive to date (1 unknown). 

Conclusion: In our experience, 35% of babies born with CDH died in the immediate neonatal period. Transfer for ECMO has been a more recent practice with 83% survival. If they underwent surgery, 30 day surgical survival was 93%. However, the overall survival of a live born baby with CDH was 53%. Therefore, when counselling parents in the antenatal period, it is important to quote all figures rather than surgical survival alone.

References
1. Robinson PD, Fitzgerald DA. Congenital diaphragmatic hernia. Paediatric Respiratory Reviews 2007:8:1526-0542

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