Congenital diaphragmatic hernias: eleven years' experience
H. G. Mishalany, K. Nakada and M. M. Woolley
Fifty-five patients with congenital diaphragmatic hernias (1966 to 1976)
were studied and compared to 65 similar patients reported previously (1953
to 1963). The mortality was found to be the same in the two groups despite
the fact that in the current series, patients were diagnosed and operated
on at a younger age. Initial uncorrected pH value was found to be of
prognostic importance. All babies whose initial uncorrected pH was greater
than 7.0 survived and almost all those whose pH was less than 7.0 died,
with the group in-between having a 50% chance of survival. Earlier
operation and correction of acidosis did not substantially improve the
chance of survival. Hypoplasia of the lungs and major cardiovascular
anomalies contributed to death in a number of patients. Pulmonary
hypertension causing a right-to-left shunt was responsible for the deaths
of others and, therefore, the use of vasodilator drugs deserves further
evaluation.
