Experience in the Management of Eighty-Two Newborns With Congenital Diaphragmatic Hernia Treated With High-Frequency Oscillatory Ventilation and Delayed Surgery Without the Use of Extracorporeal Membrane Oxygenation

Abstract

The aim of this study is to analyze neonatal outcome of isolated congenital diaphragmatic hernia and to identify prenatal and postnatal prognosis-related factors. A retrospective single institution series from January 2000 to November 2005 of isolated congenital diaphragmatic hernia neonates was reviewed. Respiratory-care strategy was early high-frequency oscillatory ventilation, nitric oxide in pulmonary hypertension, and delayed surgery after respiratory and hemodynamic stabilization. Survival rate at 1 month was 65.9%. None of the prenatal factors were predictive of neonatal outcome, except an intra-abdominal stomach in left diaphragmatic hernia. Preoperative pulmonary hypertension was more severe in the nonsurvivor group and was predictive of length of ventilation in the survivors. During the first 48 hours of life, the best oxygenation index above 13 and the best PaCO2 above 45 were predictive of poor outcome. When treating isolated congenital diaphragmatic hernia with early high-frequency ventilation and delayed surgery but excluding extracorporeal membrane oxygenation, survival rates compare favorably with other reported series, and the respiratory morbidity is low.

Congenital diaphragmatic hernia: prognostic indices in the fetal endoluminal tracheal occlusion era

“…It incorporates an appreciation of how difficult it is to ventilate such infants and their capacity to respond in terms of blood gas levels and is a fundamental variable. A French group recently reported its predictive value and came to similar conclusions in a retrospective evaluation of their CDH infants [15]. It is of course widespread in evaluation of the need for ECMO [16] and in assessment of older ventilated children [17].…”

Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia

“…All inborn babies were treated with the same protocol [40] . Briefly, they were intubated in the delivery room and immediately admitted to the neonatal intensive care unit.…”

Perioperative course of pulmonary hypertension in infants with congenital diaphragmatic hernia: impact on outcome following successful repair

“…In an effort to improve the outcome of CDH, many centers have included the preoperative stabilization with delayed surgery in the management of patients with CDH [4][5][6]. However, the results of these strategies are not always guaranteed because some difficult infants with CDH, who were thought to be stabilized and ready for surgery, were at risk for recurrent PH and death after surgical repair [7].…”