Congenital diaphragmatic hernia: 22 years experience in a single tertiary medical center.

BACKGROUND Over the last two decades, the epidemiology, treatment strategy and mortality rate for congenital diaphragmatic hernia have changed. OBJECTIVES To retrospectively analyze our experience with CDH of the last 22 years. METHODS We reviewed the charts of all infants suffering from CDH between 1985 and 2007. Prenatal and maternal as well as perinatal and neonatal data were collected, including outcome parameters. The 71 infants that we identified were divided into two historical groups: from 1985 to 1995 (group 1, 23 patients) and from 1996 to 2007 (group 2, 45 patients). RESULTS There was an increase in the incidence of prenatal diagnosis and a subsequent significant decrease in gestational age at diagnosis in group 2 (25 weeks gestation, compared with 30 weeks gestation in group 1, P = 0.018). In addition, we noted a trend toward a reduced number of infants with right-sided hernia and associated cardiac anomalies. The timing to post-delivery surgery was significantly longer in group 2 (20 hours in group 1 vs. 53 hours in group 2, P < 0.001). A significant reduction in postoperative mortality was demonstrated in group 2 compared with group 1 (13.5% vs. 38.7% respectively, P = 0.04), CONCLUSION Our data suggest a higher survival rate for operated infants in group 2 during the last decade, probably due to changes in preoperative methods of treatment as well as later surgery timing compared to group 1. We speculate that today's cases of congenital diaphragmatic hernia are probably milder than in the past due to earlier and more detailed prenatal diagnosis and subsequent termination of pregnancies for the more severe forms of the disorder.