Outcome of neonates operated on for congenital diaphragmatic hernia

Introduction

Congenital diaphragmatic hernia (CDH) is a severe disorder in neonates. The prognosis has been improved in the past 10 years by a combination of HFO ventilation, sedation and analgesia, nitric oxide and delayed surgery. Extracorporeal oxygenation (ECMO) has been proposed by certain teams. A decrease in mortality from 70% to approximately 40% has recently been reported [1,2]. However, little is known about the outcome of such patients. We report the outcome of a group of patients after 10 years' follow-up.

Patients and methods

A retrospective review was undertaken of neonates admitted to the paediatric intensive care unit after 1 January 1992 (date at which new treatment methods were introduced in the department) and operated on for congenital hiatus hernia.

Results

Nineteen neonates were reviewed, of whom seven died (36%) and 74% had left hernia. Two of the 12 remaining survivors had other malformations (cardiac and urogenital). Mean age at the time of surgery was 17 hours. Median ventilation duration was 6 days. Median duration of intensive care was 12.5 days. 58% children were discharged from intensive care unit with oxygen therapy and median hospitalization duration was 31 days. Mean age at the last consultation was 18 months (SD 18). Six infants required readmission and four had severe respiratory disorders (one with severe bronchiolitis, one with asthmatiform bronchitis and one with chronic clinical respiratory insufficiency). One infant was hospitalized for more than 12 months and required left pneumonectomy and tracheotomy. Six infants had gastro-esophageal reflux, of whom one required surgery. This infant also had residual hiatus hernia and scoliosis. Three infants had neurological sequelae (one with psychomotor retardation and two with overall hypotonia, one of whom had problems with swallowing).

Discussion

Our results showed that 1) the mortality was similar to those reported by the other two French series [1,2] (36%) despite the lack of use of ECMO and 2) middle-term morbidity was low compared to the mortality reported after ECMO [1].