Related Experiment Videos
Timing of surgery in congenital diaphragmatic hernia. Low mortality after pre-operative stabilisation
A J Charlton1, J Bruce, M Davenport
1North West Regional Neonatal Surgery Unit, St. Mary's Hospital for Women and Children, Whitworth Park, Manchester.
Insights
Delayed surgery for congenital diaphragmatic hernia (CDH) in newborns resulted in a 70.9% survival rate. Postmortem analysis suggests extracorporeal membrane oxygenation (ECMO) would not have significantly improved outcomes for these CDH patients.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect impacting infant survival.
- Optimal timing for surgical intervention in CDH remains a critical clinical question.
- Neonatal surgical units face challenges in managing CDH cases presenting shortly after birth.
Purpose of the Study:
- To evaluate the outcomes of a delayed surgical approach for congenital diaphragmatic hernia.
- To assess the impact of a evolving management policy on patient survival.
- To determine the potential benefit of extracorporeal membrane oxygenation (ECMO) in improving survival rates for CDH.
Main Methods:
- Retrospective review of 86 consecutive neonates with CDH presenting within 6 hours of birth.
- Analysis of patient management under a delayed surgery policy over a 6-year period.
- Correlation of postmortem findings and exclusion criteria with overall survival data.
Main Results:
- Overall survival to hospital discharge was 70.9% for the studied CDH cohort.
- A low rate of postoperative mortality was observed, with only 7 deaths (10.3% of operations).
- Analysis indicated that ECMO availability would likely have had minimal impact on overall survival rates.
Conclusions:
- A delayed surgical strategy for congenital diaphragmatic hernia is associated with considerable survival rates.
- The majority of deaths in CDH patients were attributable to factors unlikely to be mitigated by ECMO.
- Current management policies for CDH can achieve significant survival benefits without widespread ECMO use.
Abstract:
Eighty-six consecutive patients with congenital diaphragmatic hernia presenting within 6 hours of birth to a regional neonatal surgical unit were reviewed. Patients were managed under a policy of delayed surgery which has evolved during the 6-year study period. Overall survival (to leave hospital) was 70.9%. There were only seven postoperative deaths (10.3% of operations). Analysis of the 25 deaths in the light of postmortem findings and published exclusion criteria indicates that the availability of extracorporeal membrane oxygenation would have made little difference to overall survival.