Left-sided congenital diaphragmatic hernia: can we improve survival while decreasing ECMO?

• Published in: Journal of perinatology Vol. 40; no. 6; pp. 935 - 942
• Main Authors: Yang, Michelle J., Fenton, Stephen, Russell, Katie, Yost, Christian Con, Yoder, Bradley A.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.06.2020; Nature Publishing Group
• Subjects: 692/308/409; 692/699/1785; 692/700/1720; Analysis; Diaphragm; Genetic disorders; Hernia; Hernias; Medicine; Medicine & Public Health; Neonates; Neonatology; Nitric oxide; Oxygen content; Pediatric Surgery; Pediatrics; Regression analysis; Saturation; Stimulation; Survival; Thorax
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-020-0615-3

Background Mortality and ECMO rates for congenital diaphragmatic hernia (CDH) remain ~30%. In 2016, we changed our CDH guidelines to minimize stimulation while relying on preductal oxygen saturation, lower mean airway pressures, stricter criteria for nitric oxide (iNO), and inotrope use. We compared rates of ECMO, survival, and survival without ECMO between the two epochs. Design/Methods Retrospective review of left-sided CDH neonates at the University of Utah/Primary Children’s Hospital NICUs during pre (2003–2015, n  = 163) and post (2016–2019, n  = 53) epochs was conducted. Regression analysis controlled for defect size and intra-thoracic liver. Results Following guideline changes, we identified a decrease in ECMO (37 to 13%; p  = 0.001) and an increase in survival without ECMO (53 to 79%, p  = 0.0001). Overall survival increased from 74 to 89% ( p  = 0.035). Conclusion(s) CDH management guideline changes focusing on minimizing stimulation, using preductal saturation and less aggressive ventilator/inotrope support were associated with decreased ECMO use and improved survival.