| Purpose:The study aimed to describe the clinical features and analysis the risk factors with early death in congenital diaphragmatic hernia (CDH) in neonates to improve the prognosis.Methods:The author retrospectively reviewed the medical records of neonates with CDH admitted in the Affiliated Children's Hospital of Zhejiang University School of Medicine between January 2003 and December 2010 with collecting items including: gender, age of admission, gestation age, birth body weight, prenatal diagnosis record, location of diaphragmatic hernia, clinical symptoms, length of stay, Apgar scores at 1st minute and 5th minute, the arterial blood gas (ABG) results when admission and after surgery (including:pH, oxygen pressure PaO2, carbon dioxide pressure PaCO2), duration of mechanical ventilation, ratio of high frequency oscillatory ventilation (HFOV) using, fraction of inspired oxygen (FiO2), ratio of placing draining tube, ratio of prosthetic material using in surgery, number of dead patients. All CDH patients screened whether abnormities in other organ by ultrasonography in heart, abdomen and brain. Pulmonary hypertension was assessed by Doppler ultrasound in heart. The patients divided into two groups according to whether age when admission is less than 72 hours(≤72 hours group and＞72 hours group), comparing difference in the clinical symptoms distribution and major treatment in the two groups. According the short term prognosis (survival or death), patients divided into survival group or death group. Analysis the risk factors associated with early death. Results:1. A total of 59 neonates enrolled this study.35 were male and 24 were female.51 cases were left-sided while 8 cases were right-sided.11 cases had prenatal diagnosis. Gestation age was 38.96±1.86 weeks. The birth body weight was 3.17±0.49kg. Apgar scores at 1st minute was 7(3,10) and the 5th was 8(3,10). Age of admission was 14(0.25,648.00) hours. The pH of ABG at admission was 7.26±0.16. There were 26 cases with other abnormities and 7 cases with pulmonary hypertension.2.≤72 hours group had a higher ratio in cyanosis (35/47) than＞72hours group (2/12) (P＜0.01);≤72 hours group had a lower ratio in tachypnea (11/47) than＞72hours group(8/12)(P＜0.05). Both groups had one patient with vomiting and age＞72hours group had a case with decreasing foodintaking.≤72 hours group had a higher ratio in mechanical ventilation (26/47) than＞72hours group (2/12) (P＜0.05).3. 38 patients took the surgery with 3 pulmonary hypertension cases. Preoperative time was 2(1,8) days.14 cases had mechanical ventilation before surgery with duration of 2(1,5) days. Gortex patch was used in 2 cases while dacron patch was used in 1 case.19 cases had intrathoracic drain tubes after surgical repair. The mechanical ventilation time after surgery is 2(1,9) days. Length of stay was 15±5 days.4 patients died after surgery. The oxygen index (OI) after surgery was (276±173) higher than the OI before surgery (456±266)(P＜0.01).4. The survival rate was 64.29%. The survival group had a lower ratio of other abnormities (33.33% vs 65,00%) (P＜0.05), heavier birth body weight (3.30±0.51kg vs 2.96±0.39kg) (P＜0.05), higher Apgar scores at 5th minute [9(6, 10) vs 8(3,10)] (P＜0.05) than the death group. The survival group had a higher pH in ABG when admission (7.31±0.11 vs 7.17±0.19) (P＜0.01), a higher OI [243(40,942) vs 89(38,378)] (P＜0.01) and a lower alveolar-arterial difference of oxygen pressure (AadO2) [57(13,552) mmHg vs 336(16,614) mmHg] than the death group. The survival group had a lower ratio of required mechanical ventilation (33.33% vs 75.00%) (P＜0.05), lower ratio of required HFOV mode (11.11% vs 50.00%) (P＜0.01) than the death group.Conclusion:CDH in neonates had a high mortality. The major cause of death was respiratory failure caused by pulmonary hypoplasia and accompanied with pulmonary hypertension. The standard management in preoperative and postoperative period could improve the curative ratio. Low birth body weight, low Apgar scores at 5th minute, high ratio of other abnormities, severe acidosis, low OI and high AadO2 when admission, high in requiring mechanical ventilation were considered as risk factors associated with early death. |
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