Identification of the main predictor of the success of treatment of congenital diaphragmatic hernia in newborns
DOI:
https://doi.org/10.15574/SP.2026.1(153).169174Keywords:
newborns, diaphragmatic hernia, pulmonary hypertensionAbstract
Congenital diaphragmatic hernia (CDH) in newborns is one of the most severe congenital anomalies with a high mortality rate. The diaphragmatic defect leads to the herniation of abdominal organs (stomach, intestines, spleen, liver) into the thoracic cavity, causing lung compression and profound dysfunction of the respiratory, cardiovascular, and digestive systems.
Aim - to establish a hierarchy of prognostic factors determining treatment success and survival rates in newborns with CDH.
A retrospective medical record review was conducted on 18 hospitalized newborns with CDH (10 males, 8 females) aged 0 to 21 days. The clinical course, instrumental findings, and the effectiveness of multidisciplinary treatment strategies were evaluated. Of the 18 patients, 12 underwent surgical repair (one postoperative death). Six infants died preoperatively due to severe refractory pulmonary hypertension (PH) and comorbidities. Clinical cases illustrate contrasting courses. A 21-day-old female with late manifestation and absent PH was rapidly stabilized and operated on. Conversely, a 1-day-old male with prenatally diagnosed CDH presented in critical condition due to severe PH and hypoxemia. He required massive pharmacological support and prolonged (72-hour) preoperative stabilization prior to type B CDH repair, followed by extended mechanical ventilation and parenteral nutrition.
Conclusions. PH severity often correlating with diaphragmatic defect size is the leading criterion determining optimal surgical timing and success; gestational age is not a decisive prognostic factor. Since standard PH therapies may fail, preoperative preparation duration must be highly individualized based on therapeutic response. Success fundamentally relies on a coordinated multidisciplinary team.
This study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children’s parents for the conduct of the study.
The authors declare no conflict of interest.
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