Bochdalek Hernia in Neonate

Kim, Dae Yeon; Kim, Seong Chul; Kim, In Koo

Abstract

PURPOSE: Repair of congenital diaphragmatic hernias (CDH) has changed from an urgent procedure to a delayed procedure during the last decade. Recently, several new therapeutic methods have been suggested, such as extracorporeal membrane oxygenation, high frequency oscillatory ventilation, partial liquid ventilation, nitric oxide (NO) inhalation, surfactant therapy, and fetal tracheal ligation. Despite recent approaches, CDH remains an unsolved problem with a mortality rate of 35% to 50%. We evaluated the clinical manifestations and the outcomes of newborns that had a Bochdalek hernia. METHODS: The charts of all neonates with a Bochdalek hernia who had been treated at the Division of Pediatric Surgery, Asan Medical Center, from May 1989 to December 1999 were reviewed (n=32). The following para meters were analyzed for survival; gestational age, birth weight, the presence of associated anomalies, the side of defect, the presence of a sac, the position of the stomach, the age at surgery, the availability of high frequency ventilation therapy, and the availability of NO inhalation therapy (1998-1999).
RESULTS
Overall, 20 of the 32 newborns survived (62.5%). The average age at gestation was 269 days (range: 202 to 288 days). The average weight at birth was 2,800 gram (range: 856-4,000 grams). There were seven major anomalies. Six patients died without repair. The average age at repair was 39.8 hours (range: 0.5 to 168 hours). The defect was left sided in 23 cases (88.5%). Four had hernia sacs. The stomach had herniated into the chest in 7 of 26 cases. Since 1998, the survival rate has been 7/10 (70.0%). The significant prognostic factors were birth weight and the presence of major anomalies (p<0.05). CONCLUSION: Birth weight and the presence of major anomalies had a significant effect on survival. In neonates with CDH, and careful long-term follow up is required to evaluate strategies using high frequency ventilation and inhaled NO.