P643 Risk factors for postoperative mortality in congenital diaphragmatic hernia: a study of 29 cases

Background Congenital diaphragmatic hernia (CDH) is one of the more common congenital anomalies with a frequency of 1/2200 live births. Despite progress in antenatal diagnosis and neonatal care, mortality for CDH remains high close to 30–40%. Several factors have been recognized as correlating with the prognosis of CDH such as pulmonary hypoplasia and pulmonary arterial hypertension. The aim of this study was to identify predictive factors of mortality after surgical management of CDH. Methods It is a retrospective study of all cases of CDH that were admitted at the neonatology department and were opered in the department of pediatric surgery in Sfax (Tunisia) from 2010 to 2018. The risk factors investigated were sex, prenatal diagnosis of CDH, gestational age, birth weight, Apgar score, left side of CDH, inhaled nitric oxide, vasoactive support, delay to surgery and surgical duration. Results During the 9-year period, twenty nine patients were included. Of those nine were wright sides and twenty were left sides. 58.6% patients were male and 41.4% were female. The mean gestational age was 38.3%. Six infants were premature. One newborn had a congenital heart disease. Antenatal diagnosis was performed in only 38% of cases (n=11).Twelve newborns had low Apgar score. The mean hospital stay was 9, 6 days. Mortality rate was 62%. There was no statistically significant difference between survival and death groups in terms of sex, prenatal diagnosis of CDH, gestational age, left side of CDH, inhaled nitric oxide and delay to surgery. However, low Apgar score and birth weight Conclusion Despite advances in neonatal reanimation, mortality for CDH remains high. Our study showed that low Apgar and low birth weight are risk factors for mortality.