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Congenital diaphragmatic hernia: experience in a single institution from 1978 through 1994
K Mallik1, B M Rodgers, E D McGahren
1Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Insights
Congenital diaphragmatic hernia survival improved significantly after the introduction of extracorporeal membrane oxygenation (ECMO). Early repair combined with ECMO support when needed offers comparable survival rates to other treatment methods.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
Background:
- Congenital diaphragmatic hernia (CDH) presents significant management challenges.
- Retrospective data collection is common due to individualized infant care.
- This study reviews institutional experience with CDH before and after ECMO implementation.
Purpose of the Study:
- To evaluate the impact of extracorporeal membrane oxygenation (ECMO) on survival rates for infants with CDH.
- To assess the institution's experience with CDH management over time.
Main Methods:
- Retrospective review of CDH infant patient records from 1978-1994.
- Analysis of survival rates before and after the introduction of ECMO in 1986.
- Evaluation of early surgical repair strategies and ECMO utilization.
Main Results:
- Overall survival rate for CDH was 63%.
- Survival rates increased from 42% (pre-ECMO) to 75% (post-ECMO).
- Infants requiring ECMO post-1986 had a 73% survival rate.
Conclusions:
- The introduction of ECMO appears to have improved survival for CDH patients.
- Current management, including early repair and selective post-repair ECMO, yields survival rates comparable to other reported series.
- Institutional experience supports ECMO as a valuable tool in CDH management.
Background:
Congenital diaphragmatic hernia continues to be a difficult management problem. Essentially all information on the condition has been compiled in a retrospective manner due to the individualized care that each infant must undergo. We contribute a review of our patients to add to the current fund of knowledge and to assess our experience before and since the introduction of extracorporeal membrane oxygenation in our institution.
Methods:
This is a review of records of infants with congenital diaphragmatic hernia treated from 1978 through 1994. Repair has generally been accomplished early with only one repair being accomplished with an infant placed on extracorporeal membrane oxygenation preoperatively.
Results:
Overall survival was 63%. Survival was 42% before extracorporeal membrane oxygenation becoming available in our region in 1986, and 75% afterward. Since 1986, 16 of 33 (48%) infants have required extracorporeal membrane oxygenation and 73% have survived.
Conclusions:
Overall survival in our series is comparable with that of other reported series. There appears to be an improvement in survival since the introduction of extracorporeal membrane oxygenation. Our present practice of early repair, and postrepair extracorporeal membrane oxygenation if needed, results in a survival rate comparable with that of currently available series reports regardless of the method of treatment reported.