Severe congenital diaphragmatic hernia (CDH): a critical analysis of eight years' experience

• Published in: European journal of pediatric surgery Vol. 12; no. 2; p. 95
• Main Authors: Bagolan, P, Casaccia, G, Nahom, A, Trucchi, A, Zangari, A, Laviani, R, Pirozzi, N, Di Liso, G, Orzalesi, M
• Format: Journal Article
• Language: English
• Published: United States 01.04.2002
• Subjects: Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic - mortality; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Survival Analysis
• ISSN: 0939-7248
• DOI: 10.1055/s-2002-30159

OBJECTIVES. 1) To define the best outcome of severe Congenital Diaphragmatic Hernia (CDH); 2) to critically evaluate deaths in order to identify possible criteria of exclusion from ECMO; and 3) to identify CDHs which could benefit from ECMO. 63 severe CDHs, 35 (55.6 %) survivors and 28 (44.4 %) nonsurvivors, subdivided into 2 groups according to age at death: Group I dying at 12 < or = 24 hours, and Group II dying at > 24 hours after birth. The three groups were compared on the basis of prenatal diagnosis, polyhydramnios, gestational age, birth weight, pneumothorax, best values of postductal PaCO 2 and PaO 2, clinical and echocardiographic signs of persistent pulmonary hypertension, and severity of pulmonary hypoplasia (i.e., body weight to bilateral lung weight ratio at autopsy). PaCO 2, PaO 2 and degree of pulmonary hypoplasia were significantly worse in Group I compared to Group II and to survivors. PaCO 2 and PaO 2 in Group II did not differ significantly from those of survivors. In severe CDH it is possible: 1) to achieve a survival rate of 56 % without ECMO; 2) to identify a group of patients (Group I = 27 %) with severe pulmonary hypoplasia who would probably die even with ECMO; and 3) to identify a group of patients (Group II = 17 %) who might benefit from ECMO treatment.