970 Congenital Diaphragmatic Hernia: Fetal and Postnatal Survival

Abstract

Background: Congenital diaphragmatic hernia (CDH) occurs in 1 in 3000 live births. A high incidence of termination of pregnancy (TOP) following antenatal diagnosis of CDH. Irish demographics may be different due to the national legislation against TOP. Methods: Retrospective 14-year study of antenatal and postnatal CDH diagnosis Results: 53 cases of CDH between 1995-2009. Data on 26 cases born at NMH were available for analysis. 19/26 cases were diagnosed antenatally at gestations ranging from 16-38 weeks and 7 were diagnosed postnatally. 7/26 had other significant congenital anomalies. 2/26 had abnormal karyotypes. 4/26 had right CDH and the remainder was left sided. The hernia contained stomach (8/26), bowel (11/26). 9/26 had mediastinal shift. 23/26 were transferred to a tertiary paediatric surgical centre and 3/26 died prior to transfer. Average LOS was 9.6 hours (range 2- 24 hours) prior to transfer. 3 were not ventilated prior to transfer and 9 needed HFOV with 12 on iNO. 2 patients were referred for ECMO one of whom survived and the other died prior to starting treatment. Survival data was available in 17/26 cases 10/17 (58%) were alive. 6/13 of those diagnosed antenatally and 4/4 of those diagnosed postnatally. 3/7 died prior to transfer. 4 died at the paediatric hospitals. 46% survival among those diagnosed antenatally but 100% if diagnosed postnatally. Conclusion: Antenatal diagnosis of CDH and other abnormalities is increasing in Ireland due to improved antenatal surveillance. Planned delivery of CDH within routine working hours enables rapid planned transfer to paediatric intensive care.