2020, Vol. 3, Issue 1, Part C

Materials and Methods: A prospective observational study was conducted in the Department of Pediatrics, I-Care Institute of Medical Sciences and Research, Haldia, from January 2019 to December 2019. Thirty neonates diagnosed with CDH who underwent surgical repair were enrolled. Demographic details, antenatal imaging findings, early postnatal clinical parameters, associated anomalies, intraoperative findings, and postoperative outcomes were documented. Predictive factors for mortality and morbidity were analyzed using univariate and multivariate statistical methods, with significance set at p<0.05.

Results: Among 30 neonates, 66.7% were diagnosed antenatally, and 60% exhibited liver herniation. The mean observed-to-expected lung-to-head ratio (O/E LHR) was 38.5%, with 46.7% having O/E LHR <35%. Pulmonary hypertension developed in 40% postoperatively. Overall mortality was 20%. Univariate analysis identified O/E LHR <35%, liver herniation, PaCO₂ >60 mmHg within 24 hours, high SNAPPE-II scores, and congenital cardiac anomalies as significant predictors of mortality. On multivariate analysis, low O/E LHR and cardiac defects remained independent predictors.

Conclusion: Low observed-to-expected lung-to-head ratio and presence of congenital cardiac anomalies are independent predictors of mortality in neonates with CDH. Early identification of high-risk neonates through prenatal and early postnatal parameters can aid in optimizing individualized management strategies and improving outcomes.