Clinical characteristics and outcomes of neonates with congenital diaphragmatic hernia at the Vietnam National Children's Hospital: a retrospective observational study.

BACKGROUND

Congenital diaphragmatic hernia (CDH) has a high mortality rate, particularly in low- and middle-income countries. This study aimed to investigate mortality rates and associated factors in CDH neonates in Vietnam.

METHODS

This retrospective observational study included CDH neonates admitted to a central children's hospital in Vietnam between November 2021 and September 2023. We collected data on neonates' characteristics, management, complications, and outcomes, comparing these data between survivors and non-survivors. We also employed logistic regression analysis to identify factors associated with hospital mortality.

RESULTS

Of 74 neonates with CDH, 64.9% (48/74) were male. The hospital mortality rate was 50.0% (37/74). The median gestational age at birth was 38 weeks (interquartile range [IQR]: 38-39), and the median age at admission was 5.2 h (IQR: 3.0-15.8). All neonates were referred from various prior hospitals, with 83.8% (62/74) requiring immediate postnatal intubation. The neonates presented in critical condition, as reflected by a median pre- and post-ductal SpO2 difference of 2.5% (IQR: 1.0-10.0), a mean pulmonary artery systolic pressure (PASP) of 51.7 mmHg (standard deviation: 18.3) on admission, and a median Oxygenation Index at 6 h of life of 13.3 (IQR: 6.8-28.2). The median peak Vasoactive Inotropic Score (VIS) during surgical intensive care unit stay was 35.0 (IQR: 15.0-80.0). High-frequency oscillatory ventilation was used as the initial ventilatory mode in 52.7% (39/74) of cases. Supportive therapies included vasopressors (84.9%; 62/73), inotropic agents (29.6%; 21/71), inhaled nitric oxide (13.5%; 10/74), Ilomedin (29.7%; 19/64), and extracorporeal membrane oxygenation (6.8%; 5/74). Surgical repair was performed in 70.3% (52/74) of neonates. Multivariable logistic regression analysis identified higher peak VIS (adjusted odds ratio [AOR]: 1.061; 95% confidence interval [CI]: 1.011-1.113; p = 0.017) and elevated admission PASP (AOR: 1.140; 95% CI: 1.041-1.247; p = 0.005) as independent predictors of hospital mortality.

CONCLUSIONS

In this selected cohort of CDH neonates admitted to a central children's hospital in Vietnam, a high hospital mortality rate was observed. The findings suggest that limited access to neonatal intensive care and surgical repair may have influenced outcomes, warranting further evaluation in similar resource-limited settings to improve care strategies.

TRIAL REGISTRATION: Not applicable.