Clinical determinants of mortality in congenital diaphragmatic hernia: a single-center cohort study from Colombia.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly associated with high neonatal morbidity and mortality. Evidence from low- and middle-income countries remains limited. This study aimed to identify clinical predictors of mortality and describe outcomes in neonates with CDH treated at a high-complexity center in Colombia. METHODS: Retrospective cohort study including all neonates with confirmed CDH managed between May 2007 and February 2026. The main outcome was in-hospital mortality. Prenatal, neonatal, respiratory, surgical, and clinical management variables were analyzed. Multivariable Poisson regression was performed among patients undergoing surgical repair. RESULTS: 91 neonates were included, with an overall survival of 54.9% (95% CI 44.5-64.9). Prenatal diagnosis was established in 74.7% of cases, and 68.1% of patients achieved sufficient stabilization to undergo surgical repair. Non-survivors had higher rates of perinatal asphyxia and lower birth weight and gestational age. Patients undergoing surgical repair showed significantly better initial oxygenation and gas exchange parameters. Among surgically treated patients, mortality was associated with non-primary repair, larger defect size, absence of hernia sac, delayed abdominal closure, and postoperative complications. In multivariable analysis, perinatal asphyxia (RR 6.1, 95% CI 2.34-16.1), intrathoracic liver position (RR 5.1, 95% CI 1.37-19.1) and left ventricular dysfunction (RR 4.0 95% CI 1.07-14.9) were independently associated with mortality, while higher birth weight was protective. CONCLUSIONS: We noted high mortality in this cohort in Colombia. Early markers of cardiopulmonary severity and anatomical severity were strongly associated with mortality, highlighting the importance of prenatal risk stratification and early multidisciplinary stabilization.