CONGENITAL DIAPHRAGMATIC HERNIA - A SINGLE CENTRE TEN-YEAR-EXPERIENCE AND MORTALITY PREVENTION LITERATURE REVIEW
DOI:
https://doi.org/10.46793/PP260119018VKeywords:
congenital diaphragmatic hernia, mortality, prevention, prenatal diagnosis, surgical treatmentAbstract
Introduction:Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly characterized by herniation of abdominal viscera into the thoracic cavity through a diaphragmatic defect. Although the etiology of CDH is multifactorial and not fully elucidated, the condition remains associated with substantial mortality despite advances in prenatal diagnosis, neonatal intensive care, and surgical management. Clinical outcomes are influenced by multiple factors, including prenatal detection, severity of pulmonary hypoplasia, associated anomalies, and the timing of surgical repair.
Objective: To present a ten-year single-center experience in the management of congenital diaphragmatic hernia and to review contemporary evidence regarding factors associated with mortality reduction.
Materials and Methods: A retrospective cohort study was conducted, including patients with CDH treated at the Clinic for Pediatric Surgery, Orthopedics and Traumatology, University Clinical Center Niš, between 2016 and 2025. Demographic and perinatal characteristics, prenatal diagnosis, anatomical characteristics of the defect, need for respiratory support, timing of surgical repair, and clinical outcomes were analyzed.
Results: The study included 17 patients, 76.5% of whom were male. Left-sided CDH was registered in 82.4% of patients. In four patients (23.5%), CDH manifested itself later, in the period from the fifth month of life to the tenth year. Prenatal diagnosis was established in 11.8% of cases. Immediately after birth, eight patients (61.5%) required mechanical ventilation support, while five patients (38.5%) were initially administered oxygen therapy exclusively. Surgical intervention is usually performed after 48 hours, at the latest on the 7th day of life. A fatal outcome was recorded in 23.5% of patients.
Conclusion: Congenital diaphragmatic hernia remains a major therapeutic challenge with persistently high mortality. Prenatal diagnosis, structured postnatal stabilization, normalization of pressure in the pulmonary artery system, and individualized timing of surgical intervention are critical determinants of outcome. Further prospective, multicenter studies are warranted to refine management strategies and improve survival in this high-risk neonatal population.
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