Congenital diaphragmatic hernia—are we being too optimistic?

The survival rate for isolated, congenital diaphragmatic hernia (CDH) remains variable, with quoted rates of between 10 and 35%. Despite the increased detection of CDH, our recent experience would suggest that survival rates are lower in our centre. Our objective, therefore, was to ascertain the survival rate for babies with isolated antenatally diagnosed CDH. Cases were identified from the Fetal Medicine Database, Neonatal unit admission records and paediatric surgical logbooks 1997–2002. Over the study period 64 cases of CDH were identified. Of these 11 (17%) were terminated; a further six were excluded because the hernia occurred in association with other abnormalities and in four cases data were incomplete. This left 43 in our study population. Of these 31 (72%) were left-sided and 11 (25%) right-sided and 1(3%) bilateral. Twenty-eight (65%) were diagnosed antenatally. The survival rate for CDH diagnosed antenatally was 32% (all left-sided). Thirty-five per cent were diagnosed postnatally (73% left and 20% right, 7% bilateral). The survival rate for the postnatally diagnosed group was 93%. The one neonatal death was a right-sided CDH.