Outcome of congenital diaphragmatic hernia: analysis of implicated factors

Minerva Pediatr. 2013 Jun;65(3):279-85.


Aim: Congenital diaphragmatic hernia remains a significant challenge for neonatologists and pediatric surgeons. Over the last years, new therapeutic approaches, as high-frequency oscillatory ventilation, inhaled nitric oxide, permissive hypercapnia, extracorporeal membrane oxygenation, have been used for the management of these newborns. We conducted a retrospective study of all infants who were managed for congenital diaphragmatic hernia in our NICU in order to identify possible clinical characteristics which were predictive for survival.

Methods: We reviewed a single institution's experience with 42 consecutive neonates with congenital diaphragmatic hernia admitted to our NICU from 1993 to 2009.

Results: Prenatal data and side of congenital diaphragmatic hernia were similar in survivors and no-survivors infants except for the lung-to-head ratio (LHR), which was higher and measured later in survivors than non-survivors. Multiple regression analysis showed that a gestational age ≥39 weeks, Apgar score at 5 min ≥7, FiO2<0.35, MAP<13 cmH2O, OI<10 and AaDO2 >282 before surgical repair, and the absence of persistent pulmonary hypoplasia were independent predictive factors of survival.

Conclusion: Our study suggests that the outcome of newborns with congenital diaphragmatic hernia still depends on the severity of lung hypoplasia, despite the different respiratory and therapeutical approaches.

Publication types

  • Comparative Study

MeSH terms

  • Extracorporeal Membrane Oxygenation / methods
  • Female
  • Hernia, Diaphragmatic / diagnosis
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / surgery
  • Hernia, Diaphragmatic / therapy
  • Hernias, Diaphragmatic, Congenital*
  • Herniorrhaphy / methods
  • High-Frequency Ventilation / methods
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Nitric Oxide / administration & dosage
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome


  • Nitric Oxide