PROGNOSIS OF CONGENITAL DIAPHRAGMATIC-HERNIA

Congenital diaphragmatic hernia (CDH) contributes significantly to per inatal morbidity and mortality, This retrospective study examines the experience of a major teaching hospital to establish survival rates an d factors influencing outcome. Survival rates were found to relate clo sely to the stage at which the diagnosis was made and the presence of associated anomalies. Ultrasound diagnosis early in pregnancy is assoc iated with a higher mortality rate than diagnosis made late in pregnan cy or after delivery. Logistic regression analysis and chi-squared ana lysis did not establish to a significant degree that any factor, alone or in combination, was a reliable prognostic indicator, It is acknowl edged, however, that figures in this series are small, Survival figure s are presented to facilitate reliable parental counselling, In partic ular, the presence of associated major anomalies and the gestational a ge at which diagnosis is made are of critical importance in accurately counselling parents regarding the prognosis for survival, In this stu dy, excluding terminations, the mortality rate for isolated CDH diagno sis before the 21st week was 45.5%, with a corresponding survival rate of 54.5%. Once the infant was liveborn, however, the survival rate ro se to 68.0%, and if the infant survived transfer to a paediatric surgi cal unit, the survival rate in this study was 73.9%.