Predictors of Mortality among Neonates with Congenital Diaphragmatic Hernia: Experience from an Inborn Unselected Cohort in India.

OBJECTIVE

To evaluate the clinical profile and predictors of mortality in neonates with congenital diaphragmatic hernia (CDH).

METHODS

Demographic and clinical parameters of neonates with congenital diaphragmatic heria (n=37) between January 2014 and October, 2017 were reviewed, and compared among those who survived or expired in hospital.

RESULTS

Median (range) gestation and birthweight were 38 (37-39) weeks and 2496 (2044-2889) g, respectively. Persistent pulmonary hypertension (PPHN) was documented in 19 (51%) neonates and 10 (27%) had associated malformations. Surgery could be performed in 18 (49%), overall mortality was 60%. On univariate analysis, low Apgar scores, presence of malformations, PPHN, need for higher initial peak inspiratory pressure/high frequency ventilation, and requirement of a patch for closure were associated with increased mortality. On multivariate analysis, PPHN remained the only significant risk factor [adjusted RR 3.74 (95% CI 1.45-9.68)].

CONCLUSIONS

The survival of infants with CDH is low, and PPHN is an important predictor of mortality.