44 Does Presence Of A Hernia Sac Improve Survival In Newborns With Congenital Diaphragmatic Hernia ?
Wajid Jawaid1,2, Keerthika Sampat3,4, Paul Losty1,5
1Institute of Child Health , University of Liverpool, Liverpool, United Kingdom. 2Department of Paediatric Su, Liverpool, United Kingdom. 3Institute of Child Health, University of Liverpool, Liverpool, United Kingdom. 4Department, Liverpool, United Kingdom. 5Department of, Liverpool, United Kingdom

Abstract

Aims

A growing body of literature suggests that the presence of a hernial sac (HS) in newborns with congenital diaphragmatic hernia (CDH) may improve prognosis. By examining a large cohort of CDH babies admitted to our centre we aimed to establish if the presence of HS is a robust independent predictor of improved survival.

Methods 

All CDH patients admitted to a single centre were recruited. Post neonatal presentation and Morgagni hernias were excluded. Demographics, defect type, laterality, survival and recurrence were recorded.

Results  

192 CDH cases were managed in a 20 year period during 1997 - 2017. Ten babies had Morgagni hernia and 29 remaining cases diagnosed beyond the neonatal period were excluded. Analysis was undertaken in 153 newborns with Bochdalek hernia. There were 53 females giving a statistically significant male to female preponderance with a ratio of 1.89 (p = 0.0002 , Binomial test). Twenty two (14%) newborns had a HS. Survival with a HS was 21/22 (95%) vs 108/131 (82%) without HS ; non significant (p = 0.20, Fisher's Exact Test). No difference(s) in HS incidence were identified by sex  (M:F 15% vs 13.2%, p = 0.81, Fisher's Exact Test). Subgroup analysis according to gender found the presence of HS showed a consistent trend towards improved overall survival in both sexes (100% vs 87% in females, 93% vs 80% in males ). 

Conclusion

Like early published studies recording a significant survival advantage with the presence of a HS we herein demonstrate a trend towards improved survival for CDH patients with a HS. These findings were also consistent between sexes. Future multicentre studies and registry(s) may provide additional data to fully answer this hypothesis. 

 


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