Israel Medical Association Journal

Background: This study provides valuable insight on the importance of antenatal follow-up, despite advances in medical capabilities.

Objectives: To provide current information on mortality rates and causes including demographic parameters.

Methods: A total of 3362 infants were admitted to the neonatal intensive care unit at Kaplan Medical Center between 2009 and 2021. Retrospective data were extracted from a computerized prospective database and further divided to two groups: 2009–2014 and 2015–2021. For sequential variables, we calculated the mean, standard deviation, and median. For categorical variables we calculated the prevalence and performed a chi-square test. The sequential variables did not show a normal distribution according to the Shapiro-Wilk test. Therefore, the A-parameter Mann-Whitney test was used. Results were considered significant when the P-value < 0.05.

Results: A decrease in the death rate was found, but when evaluating the infants who died, a decrease in full antenatal follow-up from 55.2% to 31.5% was seen (P-value = 0.06).

Conclusions: Despite advancements in medical knowledge and capabilities, an association was found between increased mortality and reduced antenatal follow-up.

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[1] 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 them into two historical groups: from 1985 to 1995 (group 1, 123 patients) and from 1996 to 2007 (group 2, 45 patients).

Results: We found 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 1 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.