MORTALITY AMONG INFANTS WITH HIGH-RISK CONGENITAL DIAPHRAGMATIC-HERNIA IN SINGAPORE

Several factors suggested to predict mortality in congenital diaphragm atic hernia (CDH) have not always been applicable in different centers . A retrospective review was conducted of 19 consecutive neonates in S ingapore in whom CDH was diagnosed within 12 hours of birth to identif y factors associated with mortality. Of the 19 cases, 15 (79%) were di agnosed using antenatal ultrasonography. Eight (42%) underwent primary repair at a median age of 23 hours (range, 12 to 50 hours). Of the 19 infants, 15 died (mortality rate, 79%). Survivors until hospital disc harge were compared with nonsurvivors. Antenatal diagnosis and stomach position in left-sided defects had no effect on outcome, although pol yhydramnios tended to be associated with nonsurvival. Significant post natal factors associated with mortality included a tow initial arteria l pH level, tow initial arterial-alveolar oxygen ratio, high initial a lveolar-arterial oxygen gradient, as well as high oxygenation and vent ilation indices. These results reflect difficulty in oxygenation becau se of pulmonary hypoplasia despite evidence of adequate ventilation. T here was no difference between survivors and nonsurvivors in either th eir initial or best postductal blood gases. The ''Bohn quadrants'' did not aid in predicting survival of infants who underwent repair becaus e all eight such infants had best postductal carbon dioxide values of less than 40 mm Hg and ventilation indices of less than 1,000. Yet onl y four (50%) survived until hospital discharge. Large-scale evaluation of these factors may be required in the future to demonstrate their v alidity and reliability because of changing management strategies for CDH. Copyright (C) 1997 by W.B. Saunders Company