Multidisciplinary treatment and prognosis of neonatal congenital severe diaphragmatic hernia

Abstract

Objective To explore the clinical profiles, multidisciplinary treatment (MDT) and prognosis of neonatal congenital severe diaphragmatic hernia. Methods A total of 42 neonatal severe congenital diaphragmatic hernia cases were reviewed from September 2007 to April 2017. They were divided into MDT group (n=23) and non-MDT group (n=19). Gender, age, birth weight, gestational age, prenatal diagnosis, Apgar score, hepatic position, defect size and prognosis were reviewed. And t-test, rank-sum test and analysis of variance were performed. Results Prenatal diagnosis (17% vs 4%, P=0.011) and 1min Apgar score [(6.2±1.7) vs (7.2±1.4), P=0.044] had great prognostic impacts. However, lung-to-head ratio, hepatic position and defect position showed no significant statistical differences. As compared to non-MDT group, the average 1min Apgar score [(6.2±1.7) vs (7.2±1.4), P=0.044], ratio of prenatal diagnosis (91.3% vs 57.9%, P=0.030), ratio of transfer (92.3% vs 47.3%, P=0.002), gestational age of prenatal diagnosis [(26.4±5.5) vs (31.6±7.2), P=0.020], proportion of endoscopic surgery (13∶5 vs 2∶11, P=0.003), ventilator support time [(6.8±2.7) vs (4.1±2.3) days, P=0.024] had significant statistical differences. However, birth weight, gestational age, operation age, length of operation stay, survival rate and recurrence rate had no intergroup difference. Conclusions The prognosis of neonatal severe diaphragmatic hernia is correlated with prenatal diagnosis and 1 minute Apgar score after birth. And MDT is feasible and effective for severe diaphragmatic hernia. As a non-standard intervention method, fetoscopy is feasible and widely accepted after birth. Key words: Hernia, Diaphragmatic; Infant, Newborn; Perinatal Care; Therapy; Prognosis