Which of the following is the least important prognostic factor in congenital diaphragmatic hernia ?
Correct Answer: Delay in emergent surgery
Description: Timing of surgical repair has gradually shifted from an emergency repair, to a policy of stabilization using a variety of ventilatory strategies prior to operation. •
Current recommendation is to adopt a conservative approach and delay surgical repair of the CDH until the infant stablizes from a hemodynamic and respiratory point of view.
Prognostic factors in CDI-1
Prognostic factors can be divided into:
(A) Primary prognostic factors (Pathophysiological)
These are the most important prognostic factor which affect morbidity and mortility.
These factors are:
Pulmonary hypoplasia (most important)
Pulmonary hypertension (2nd most important)
(B) Secondary or relative predictors (diagnostic/clinical)
These poor prognostic factors are:
(a) tinatal
Detection at an early gestational age (<24 wks)
Associated extradiaphragmatic congenital anomalies
Liver herniation into thorax (Liver above diaphragm)
Stomach herniationinto thorax (Stomach above diaphragm)
Presence of polyhydraminios
Small lung to head circumference ratio (LI-IR ratio)
Small fetal abdominal circumference (< than 5th percentile)
(b) Postnatal
Early age (< 6 hours) of presentation
PG, and PCO, unresponsive to ventilation
Need for extracorporeal membrane oxygenation (ECM0)
(c) Side of defect
(i) Right sided defect
Category:
Pediatrics
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