WOFAPS 2025 8th World Congress of Pediatric Surgery

Mohamad Abdullah, Stewart Cleeve, Davesh Misra, Ashwini Joshi, Ashish Desai, Paul Charelworth, Simon Phelps, Ashwath Bandi, Maricar callueng, Jean YONG

The Royal London Hospital, Barts health NHS trust

Aim of the Study:
This study evaluates the outcomes of neonates treated for congenital diaphragmatic hernia (CDH) at our centre over an 18-year period.

Method:
A retrospective case note review of neonates with CDH, admitted between January 2006 and December 2024. Demographic and outcome data were collected: survival, recurrence, complications, surgical approaches, and factors influencing prognosis. Analysis was conducted using the JASP application, and significance was assessed using Chi-Squared (p-values <0.05 were considered significant). Data are presented as median [interquartile range (IQR)].

Results:
Ninety-four neonates were identified, of whom 77 were left-sided CDH, 73 survived to operation, and the overall survival was 74%. Following surgery, right-sided CDH was associated with a higher incidence of needing a patch (40%) and a higher mortality (30%). The figures for left CDH were 7.9% and 0%, respectively. Recurrence was recorded to be in four (6.3%) left-sided CDHs and one (10%) right-sided CDH.

Factors negatively impacting survival included pulmonary hypertension, inhaled nitric oxide (50% mortality, p<0.001), and high-frequency oscillatory ventilation (63% mortality, p<0.001). A preoperative oxygenation index greater than seven was associated with mortality (p = 0.002). Long-term complications included gastroesophageal reflux (14%), chronic lung disease (1%), and long-term pulmonary hypertension (1%).

Conclusion:
CDH repair in a moderate-volume centre is associated with acceptable outcomes for operated patients. Neonates requiring advanced ventilation strategies, including Nitric oxide, high-frequency oscillatory ventilation, and inotropes, are associated with worsened survival.

Right-sided CDH was associated with a higher incidence of needing a patch and a higher mortality. Further optimisation of management protocols and long-term follow-up is essential.