Hassan Nibi, Sarma Vivek Parameswara
Department of Paediatric Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India.
J Indian Assoc Pediatr Surg. 2021 Jan-Feb;26(1):32-37. doi: 10.4103/jiaps.JIAPS_213_19. Epub 2021 Jan 11.
Congenital diaphragmatic hernia (CDH) is one of the most common neonatal emergencies, and the ideal current therapy requires high standards of neonatal care and advanced facilities. However, majority of neonates born with CDH are treated in public sector hospitals, with limitations in resources and workforce.
The aim of the study was to review and analyze the outcome of operated neonates with isolated CDH in a public sector hospital and medical college where a standard protocol of management was followed, considering the need for optimization of therapy in view of the resource constraints.
A retrospective chart review and analysis of the antenatal, preoperative, operative, and postoperative records of all neonates with operated CDH during the 3-year period from June 2015 to June 2018 at the hospital was done. The standard institutional protocol being followed included preoperative stabilization, risk stratification for patient selection, early decision regarding operative intervention, and continued postoperative ventilation.
During the 3-year period, 78 children were admitted with CDH, of which 40 newborns with operated CDH were studied. The mean age at surgery was 72 h. Thirty-five of these 40 cases (87.5%) made an uneventful recovery, while mortality was 5/40 (12.5%). All mortalities (5/40) occurred during the postoperative period after 3 days due to respiratory failure while being ventilated.
The strategy of a uniform protocol in the management of CDH adapted to the practical constraints of the institution yielded good results in the low-to-moderate risk group of neonatal CDH. The approach also facilitated the segregation of high-risk cases and optimal utilization of available facilities in a limited resources scenario.
先天性膈疝（CDH）是最常见的新生儿急症之一，目前理想的治疗方法需要高标准的新生儿护理和先进的设施。然而，大多数患有CDH的新生儿在公立医院接受治疗，这些医院资源和人力有限。
本研究旨在回顾和分析一家遵循标准管理方案的公立医院和医学院中接受手术治疗的孤立性CDH新生儿的治疗结果，考虑到资源限制，需要优化治疗方法。
对2015年6月至2018年6月这3年期间在该医院接受手术治疗的所有CDH新生儿的产前、术前、术中及术后记录进行回顾性图表审查和分析。所遵循的标准机构方案包括术前稳定、患者选择的风险分层、手术干预的早期决策以及术后持续通气。
在这3年期间，78名儿童因CDH入院，其中40名接受手术治疗的新生儿纳入研究。手术时的平均年龄为72小时。这40例中的35例（87.5%）恢复顺利，死亡率为5/40（12.5%）。所有死亡病例（5/40）均发生在术后3天后，因呼吸衰竭在通气过程中死亡。
针对机构实际限制制定的统一CDH管理方案在低至中度风险的新生儿CDH组中取得了良好效果。该方法还便于在资源有限的情况下对高危病例进行分类，并优化现有设施的利用。
