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Published on: February 5, 2021
Improved survival for infants with severe congenital diaphragmatic hernia
Jason Gien1,2, John P Kinsella3,4, Nicholas J Behrendt4,5
1Department of Pediatrics, Division of Neonatology, University of Colorado School of Medicine, Aurora, CO, United States. Jason.gien@childrenscolorado.org.
Insights
Survival for severe congenital diaphragmatic hernia (CDH) improved with early intervention. This study highlights positive outcomes using extracorporeal membrane oxygenation (ECMO) and a structured approach for infants with severe CDH.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) poses significant survival challenges, particularly in severe cases (O:E LHR < 25%).
- Current management often involves fetal endoscopic tracheal occlusion (FETO) and/or extracorporeal membrane oxygenation (ECMO).
Purpose of the Study:
- To describe single-center outcomes for infants diagnosed with severe congenital diaphragmatic hernia (CDH).
Main Methods:
- An observational study involving 13 infants with severe CDH.
- Management included ECMO, a protocolized DR algorithm, and early surgical repair.
- An innovative perioperative anticoagulation strategy was employed.
Main Results:
- 9.3% of infants (13/140) met criteria and received ECMO.
- Survival rates were 77% for ECMO and 69% for discharge.
- Median mechanical ventilation was 39 days, with a 135-day median length of stay.
Conclusions:
- Early, aggressive intervention and protocolized management can optimize survival for severe CDH.
- This approach demonstrates improved outcomes for high-risk infants.
Background:
Survival for severe (observed to expected lung-head ratio (O:E LHR) < 25%) congenital diaphragmatic hernia (CDH) remains a challenge (15-25%). Management strategies have focused on fetal endoscopic tracheal occlusion (FETO) and/or extracorporeal membrane oxygenation therapy (ECMO) utilization.
Objective(S):
Describe single center outcomes for infants with severe CDH.
Study Design:
Observational study of 13 severe CDH infants managed with ECMO, a protocolized DR algorithm, and early repair on ECMO with an innovative perioperative anticoagulation strategy.
Results:
13/140 (9.3%) infants met criteria and were managed with ECMO. 77% survived ECMO and 69% survived to discharge. 22% underwent tracheostomy. Median days on mechanical ventilation was 39 days (IQR 22:107.5) and length of stay 135 days (IQR 62.5:211.5). All infants received a gastrostomy tube (GT) and were discharged home on oxygen and pulmonary hypertension (PH) meds.
Conclusion:
Survival for infants with severe CDH can be optimized with early aggressive intervention and protocolized algorithms (149).
