Acıbadem Üniversitesi Sağlık Bilimleri Dergisi Online Early
A Retrospective Evaluation of "very High Risk" Patients With Congenital Diaphragmatic Hernia
Şenol Emre1,Rahşan Özcan1,Ali Ekber Hakalmaz1,Gonca Tekant1,Ergun Erdoğan1,Sinan Celayir1
1İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Istanbul, Türkiye Objective: To evaluate the diagnosis and treatment of "very high-risk" patients with Congenital Diaphragmatic Hernia (CDH).

Patients and Methods: Medical records of the CDH patientstreated in our clinic between the years 2005-2015 were reviewed, retrospectively. Before 2005, patients with 80 and higher a modified ventilation index (MVI) equals to 80 and higher were defined as high-risk patients. Later on, <28 weeks of prenatal diagnosis and the need for intubation were added as additional risk factors. In this study, cases with these three risk factors were defined as "very high-risk" patients. The gestational week of prenatal diagnosis, birth week and weight at birth, time of first intubation, MVI values, anti-pulmonary hypertensive treatment choices, operative time (surgery time?) and surgery method and survival rates were evaluated.

Results: Sixteen of the 67 patients with CDH were in the "very high-risk" group. The mean prenatal diagnosis week was 25.2 (15-28) GW. The Mmean birth week was 37.4 (32-40) GW and the mean weight at birth was 2850 (1400-3315)g. All patients were intubated instantly after birth. The Mmean MVI value was 111.1(80-267) for the "very high-risk" group. In addition to the conventional "gentle ventilation" strategy, oral Sildenafil and inhaled Nitric Oxide were administered to seven patients recently. Survival rate was 19% (3/16) in the "very high-risk" group, whereas 50% (3/6) in patients who underwent surgery.

Conclusion: Determination of high-risk groups is of crucial importance in CDH. Herein, risk factors for the "very high-risk" group were determined as following: MVI, prenatal diagnosis week and need for immediate intubation after birth. Despite the high mortality rates obtained, Sildenafil and inhaled Nitric Oxide treatment may have had positive effects on survival rate in this group. Keywords : Congenital diaphragmatic hernia, pulmonary hypertension, prenatal diagnosis, modified ventilation index