Congenital Diaphragmatic Hernia: Don’t Haste Surgery.

Abstract

The management of congenital diaphragmatic hernia (CDH) in 12 neonates who had the onset of symptoms in the first 24 hours of birth was studied prospectively. The aim of study was to assess the efficacy of prior stabilization by conventional medical therapy and determine the optimum time for successful surgery. Arterial blood gas analysis showed pH below 7 in 5(41.7%) neonates, between 7 and 7.2 in 3 (25%) and more than 7.2 in 4 (33.3%) cases. Arterial pO2 was less than 40 mmHg in 4 (333%) cases, between 40 and 80 mmHg in 6(50%) and more thin 8OmmHg in 2(16.6%) cases. The best pH obtained during stabilization period was 7 to 7.2 in 3(25%) and more than 7.2 in 9(75%) cases whereas best possible pO2 obtained was between 70-80mmHg in 2(16.6%), cases and above 80mmHg in 10 (83.3%) cases. Mean time period for prior stabilization was 36.2 hours. Mortality rate was 41.7% in neonates stabilized preoperatively whereas it was 93.4% where earlier policy of urgent surgery was adopted. The authors recommend that prior stabilization followed by delayed surgery results in a survival rate superior to that associated with early operation in neonates with CDH.