Is it possibble to predict survival in cases with congenital diaphragmatic hernia?

Abstract

Objective: This study was planned to determine whether there is a correlation between diagnosis criteria and survival and morbidity rates and to show the importance of blood gas values taken in the first 24 hours with a view to prognostic survival predictions in newborns with CDH treated and followed at our department.

Material and Method: This study was carried out prospectively covering newborns with CDH treated and followed between January 2006 and May 2009. For the gathering of data; demographic features, diagnostic time (prenatal/postnatal), all findings of laboratory and radiology, treatment characteristics, early stage post-operative complications, and results were evaluated.

Results: 37 newborn with congenital diaphragmatic hernia were hospitalized, followed and treated at our department during 29 months period. 18 were female (48.6%) and 19 were male (51.4%). Prenatal diagnosis was made in 30.3%. Ultrasonography showed polyhydramnios in 5 out of 15 cases (41.6%) diagnosed prenatally and polyhydramnios with intrathoracic stomach in 3 cases (25.1%). Spontaneous delivery was happened in 54.5%. Hernia was on the left side in 72.7% of the patients, and 21.7% of patients had involved major anomalies. The difference between dying and surviving cases was found statistically significant according to 1st and 5th minute APGAR scores, and MAP, VI, MVI, OI, PIP values, and existence of major anomalies.

Conclusion: This study demonstrated that the prenatal diagnosis before 25th week, existence of major anomalies, 1st and 5th minute APGAR scores, PIP, OI and MVI values may be used in order to make a prediction as a prognostic factor in cases with CDH. Although statistically significant relationship between the mortality rate and polyhydramnios and/or prenatal diagnosis and survive were not significantly; lower than 40 of the MVI was found to be helpful in positive predicting on survival of cases with CDH.

Keywords

• Congenital Diaphragmatic Hernia
• prenatal diagnosis
• prognostic factor
• mortality

Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?

Öz

Amaç: Bu çalışma, konjenital diyafragma hernili (KDH) olgularda prenatal tanılama kriterlerinin veya postnatal erken klinik ve laboratuvar bulgularının prognoza etkisinin gösterilmesi ve buna göre yaşamsal öngörüde bulunabilmek amacıyla planlanmıştır.

Gereç ve Yöntem: Çalışma Ocak 2006 ve Mayıs 2009 tarihleri arasında kliniğimizde takip ve tedavi edilen KDH olgularında ileriye dönük olarak yapıldı. Olguların tanı zamanı, doğum yeri ve şekli, demografik özellikler, fizik muayene ve laboratuvar bulgular, tedavi ve sonuçlar değerlendirildi.

Bulgular: 29 aylık sürede 33 konjenital diyafragma hernili yenidoğanın 17’si erkek (%51,5), 16’sı kız (%48,5) olup; anne yaş ortalaması 25,18±5,34 yaş, gestasyon yaş ortalaması 36,8±3,36 hafta, doğum kilosu ortalaması 2742,12±701 gr. idi. %30,3’ünün (n:10) prenatal tanısının olduğu, %54,5’inin (n:18) normal spontan vajinal yolla doğduğu; %72,7’sinde (n:24)  diyafragmatik herninin solda olduğu; %21,2 olguda (n:7) majör anomalilerin eşlik ettiği belirlendi. Ameliyat sonrası 10 olgu (%33) yaşadı. Sağ kalım oranı MVI 40 ve altında olanlarda, 40 üzeri olanlara göre göre anlamlı düzeyde yüksek bulundu.

Sonuç: Çalışmada KDH olgularında 25. haftadan erken tanı, majör anomaliler, 1. ve 5. dakika APGAR skorları, PIP, OI ve MVI değerlerinin prognostik açıdan öngörüde kullanılabileceği gösterildi. KDH’li olgularda prenatal tanılama ile sağkalım arasında veya polihidramnios ile ölüm oranı arasında istatistiksel açıdan anlamlı ilişki saptanamazken, MVI indeksinin 40’ın altında olmasının sağ kalım üzerinde pozitif öngörüde bulunmaya yardımcı olduğu saptandı. 

Anahtar Kelimeler

• Konjenital Diyafragma Hernisi
• Prenatal Tanı
• Prognostik Faktör
• Mortalite

Kaynakça

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