Predictors of Mortality among Neonates with Congenital Diaphragmatic Hernia: Experience from an Inborn Unselected Cohort in India

Objective: To evaluate the clinical profile and predictors of mortality in neonates withcongenital diaphragmatic hernia (CDH). Method: Demographic and clinical parameters ofneonates with congenital diaphragmatic heria (n=37) between January 2014 and October,2017 were reviewed, and compared among those who survived or expired in hospital.Result: Median (range) gestation and birthweight were 38 (37-39) weeks and 2496 (2044-2889) g, respectively. Persistent pulmonary hypertension (PPHN) was documented in 19(51%) neonates and 10 (27%) had associated malformations. Surgery could be performed in18 (49%), overall mortality was 60%. On univariate analysis, low Apgar scores, presence ofmalformations, PPHN, need for higher initial peak inspiratory pressure/high frequencyventilation, and requirement of a patch for closure were associated with increased mortality.On multivariate analysis, PPHN remained the only significant risk factor [adjusted RR 3.74(95% CI 1.45-9.68)]. Conclusion: The survival of infants with CDH is low, and PPHN is animportant predictor of mortality.