Determinants of Postoperative Mortality in Neonates with Congenital Diaphragmatic Hernia: A Prospective Observational Study from a Tertiary Care Centre, Southern India

Introduction: Congenital Diaphragmatic Hernia (CDH) is a lifethreatening developmental anomaly characterised by a defect in the diaphragm that allows abdominal viscera to herniate into the thoracic cavity, leading to pulmonary hypoplasia and pulmonary hypertension. Despite advances in prenatal diagnosis, neonatal intensive care, and surgical techniques, the management of CDH continues to pose considerable clinical challenges, particularly in resource-constrained settings. Aim: To determine the outcomes and identify the risk factors associated with mortality in neonates undergoing surgical repair for CDH. Materials and Methods: The present hospital-based prospective observational study was conducted in the Departments of Paediatrics, Neonatology, and Paediatric Surgery at Government Medical College, Kozhikode, Kerala, India, from 1st January 2021 to 31st December 2022. All neonates diagnosed with CDH who underwent surgical repair were included in the study. The standard institutional protocol was followed, which included preoperative stabilisation, risk stratification for surgical candidacy, early decision-making regarding operative intervention, and continuation of postoperative ventilation. Results: During the study period, out of 5,850 Neonatal Intensive Care Unit (NICU) admissions, 72 neonates were diagnosed with CDH. Of these, 44 (61.1%) underwent surgical correction. The mean gestational age was 38±1.63 weeks, and the mean birth weight was 2,850±508 g. Post-repair survival to discharge was 79.5% (35 neonates), while 9 of the 44 operated neonates (20.5%) died in the postoperative period. The presence of Pulmonary Hypertension of the Newborn (PPHN), intraoperative hypothermia, postoperative air leak, and associated congenital anomalies were significantly associated with increased postoperative mortality in the present study cohort. Conclusion: Preoperative clinical stability, intraoperative hypothermia, and the presence of PPHN were found to be significantly associated with postoperative mortality in neonates undergoing surgery for CDH.