Congenital diaphragmatic hernia: mortality determinants in a Hispanic population

RESUMO

OBJECTIVES: Determine which factors were associated with mortality in our patients, specifically whether ventilatory parameters and arterial blood gas could be used to predict outcome. The role of delaying surgery and the presence of contra lateral pneumothorax were also assessed. BACKGROUND: Mortality among babies born with congenital diaphragmatic hernia remains high. The associated pulmonary hypoplasia and hypertension account for most of the overall mortality. There is no uniform consensus as to which parameters predict outcome. METHOD: Study population consisted of thirty-two patients with CDH managed during a ten-year period. Retrospective data obtained included perinatal data, postnatal complications, ventilatory parameter data, arterial blood gas, type and age of surgery. Ventilatory index, oxygenation index and arterial to alveolar oxygen difference (A-aDO2) within the first 24 hours of life and after surgical correction were compared among the 23 patients who underwent surgical correction. Timing of surgery and frequency of pneumothorax were compared between survivors and non-survivors. Epi-Info Software Package was used for statistic analysis. RESULTS: Overall survival was 40 per cent. Survival of surgically corrected infants was 61 per cent. Non-survivors had significantly higher A-aDO2 than survivors (p < 0.05). No significant differences in pCO2, ventilatory index, or oxygenation index were identified between survivors and non survivors. Surgical repair performed after the first twenty-four hours of life, was associated with a higher survival rate (p < 0.05). Fourteen patients (39 per cent) developed contralateral pneumothorax, eleven (79 per cent) of these died. CONCLUSIONS: (1) contralateral pneumothorax was associated with higher mortality, 2) A-aDO2 was a better prognostic indicator than pCO2, ventilatory index, or oxygenation index, 3) delaying surgical repair was associated with better survival rate.