Congenital (Bochdalek) diaphragmatic hernia: problems in diagnosis and management

A review of 24 children with posterolateral (Bochdalek) diaphragmatic hernia over a five-year period was carried out to highlight the problems of diagnosis and' management. Nine children were delivered in the Maternity Hospital Kuala Lumpur, giving an incidence of 1:10,000 live births which is half the expected incidence. Difficulty in diagnosis is apparent from the large number of initially misdiagnosed cases (29%) and those not detected
soon after birth (71% diagnosed after 24 hours). Less than half the babies had associated anomalies, commonest being malrotation and ipsilateral lung hypoplasia. Mortality (20.8%) appears to be related to the degree of lung hypoplasia and shunting, and the birthweight of the babies. Current evidence indicates that pulmonary hypertension is the main factor in the chain of events beginning with lung hypoplasia, which ultimately leads to their demise. Various methods to overcome this complication have been evolved which appear to give some hope for these high-risk infants.