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The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
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Outcome for infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: the first

J A D'Agostino1, J C Bernbaum, M Gerdes

  • 1Division of Neonatology, Children's Hospital of Philadelphia, PA 19104.

Journal of Pediatric Surgery
|January 1, 1995
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) significantly improved survival rates for infants with congenital diaphragmatic hernia (CDH). While most survivors experienced complications like GERD and CLD, neurodevelopmental outcomes at one year were largely average to borderline.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Critical Care

Background:

  • Congenital diaphragmatic hernia (CDH) is a severe condition with historically high mortality rates in neonates.
  • The advent of advanced respiratory support has been crucial in managing these critical cases.

Purpose of the Study:

  • To evaluate the impact of extracorporeal membrane oxygenation (ECMO) on survival rates in infants diagnosed with CDH.
  • To document the short-term medical sequelae and 1-year neurodevelopmental outcomes for CDH infants treated with ECMO.

Main Methods:

  • A cohort of 30 neonates with CDH admitted between 1990 and 1992 was studied.
  • Twenty infants requiring ECMO underwent medical and neurodevelopmental assessments at 3, 6, and 12 months post-discharge.
  • Data on neonatal course, surgical interventions, and follow-up outcomes were collected via chart review and clinical evaluations.

Main Results:

  • The survival rate for CDH infants requiring ECMO was 80% (16 of 20).
  • The overall survival rate for CDH increased from 31% to 63% following the implementation of the ECMO program (P = .01).
  • Common sequelae included gastroesophageal reflux (81%), need for tube feeding (69%), and chronic lung disease (62%). At 1 year, mean cognitive scores were average (87±23), and motor skills were borderline (75±24), with hypotonia in 10 of 13 patients.

Conclusions:

  • ECMO has substantially improved survival for neonates with congenital diaphragmatic hernia.
  • While ECMO facilitates survival, long-term management must address common sequelae such as GERD, CLD, and neurodevelopmental deficits, including borderline motor skills and hypotonia.

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