Abstract
Despite evolving evidence and increased understanding, there is a strong argument that best outcomes in managing congenital diaphragmatic hernia (CDH) patients are achieved in centers which have a high admission rate of such patients and follow standardized operating protocols of management. Pneumothorax and air leak syndromes are one of the main causes of pre- and postoperative morbidity in these patients and experts believe that delivery room sedation and gentle ventilation strategies can minimize this. We observed a significant drop in incidence of pneumothorax and reduction of mortality following implementation of standardized guidelines at the neonatal unit at Southampton which is a tertiary-level neonatal care in the southern United Kingdom and a regional referral center for CDH patients.
Highlights
A retrospective analysis was conducted for all patient discharge diagnosis data of congenital diaphragmatic hernia (CDH) from 2007 to 2016
The total number of patients admitted with the diagnosis of CDH in the specified time period was 69 (44 in the first epoch and 25 in the second epoch)
The mortality rate dropped from 16/44 patients (36.36%) in the first epoch to 2/25 (9.5%), p 1⁄4 0.01
Summary
Primary objective: This study compares outcome analysis of pre- and postimplementation of SOP with regards to mortality and incidence of pneumothorax. Secondary objectives: (1) To analyze the incidence of morbidities such as chronic lung disease and incidence of home ventilation and association of pneumothorax with these in this cohort. (2) Telephonic survey of parents with a standardized questionnaire for a crude assessment of developmental status and chronic morbidities among the discharged survivors of the cohort. Diagnosed Mean GA (wk) Mean BW (g). Mean discharge day Mean ventilation days Mean day of surgery Surgical repair Total 42/69. 37.9 (IQR: 37, 39) 3,045 (IQR: 2,641, 3,426) 20.7 (IQR: 9, 33) 9.5 (IQR: 2, 16) 3.2 (IQR: 2, 4) 52 (76.9%). Secondary objectives: (1) To analyze the incidence of morbidities such as chronic lung disease and incidence of home ventilation and association of pneumothorax with these in this cohort. (2) Telephonic survey of parents with a standardized questionnaire for a crude assessment of developmental status and chronic morbidities among the discharged survivors of the cohort.
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