MANIFESTATION AND PROGNOSIS OF CONGENITAL DIAPHRAGM DEFECTS

We conducted a retrospective examination of the data of 36 patients wi th congenital diaphragm defects detected at an early stage or even bef ore birth. The course of pregnancy, pregnancy risks, prenatal findings , mode of delivery, clinical parameters, prenatal, perinatal and postn atal procedures, findings at surgery and surgical therapy were analyze d with respect to the patients' outcome. The following factors were se en to influence the prognosis: associated anomalies, prenatal diagnosi s, maturity for age, weight, Apgar score, the size of the defect and t he extent of the pulmonary hypoplasia (and - linked to this - the pati ent's cardiorespiratory condition prior to surgery), and possibly sex. The mortality of patients surviving until surgery became possible was 28%. Our standard procedure in case of diaphragm defects known before birth is primary intubation before the child's first spontaneous brea th. We also consider the practice of delaying surgery until stabilizat ion has been achieved and especially in the incubator on the ward the course of action with the fewest complications at present from the pat ient's point of view.