Aims An observation of a high mortality over 12 months (83.3% in 2012) amongst infants with CDH prompted a retrospective review of management to evaluate outcomes over the past 5 years and compare mortality rates with the previous 5 year block. Care pathways were reviewed to see if variations in management existed within the team.
Method Data was collected retrospectively from case records as well as from foetal medicine and Neonatal Databases (January 2007–December 2012).
Results 53 cases of antenatal CDH were identified. Termination of pregnancy was performed in 15/53 (28.3%) and intrauterine death occurred in 1 case. 2 cases were excluded due to incomplete data (including 1 live birth). There were 36/53 live births (68%). 11/35 (31.4%) had an associated major anomaly. Survival to discharge rate for isolated CDH was 14/24 (58.3%) compared with 3/11 (27.3%) in the anomaly group. Overall survival to discharge rate of live births was 17/36 (47.2%). 2 infants received ECMO, both of whom survived to discharge as did all babies who underwent surgical repair of the CDH.
Conclusion There was an 11.1% mortality rate increase amongst the cohort studied when compared with the preceding 5 year block. A notably lower termination rate (28% vs. 50%) could possibly account for this, in addition to associated anomalies as above. Variations in management approach within the team was observed leading to the subsequent formulation of an evidence based protocol to improve care quality and future outcomes as current evidence suggests.
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