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Congenital diaphragmatic hernia: developing a protocolized approach

N N Finer1, A Tierney, P C Etches

  • 1Department of Newborn Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada.

Journal of Pediatric Surgery
|October 10, 1998
PubMed
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A protocolized approach to managing congenital diaphragmatic hernia (CDH) in newborns, including extracorporeal membrane oxygenation (ECMO), improved survival rates. Further trials are needed to confirm the benefits of specific protocol components.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Critical Care

Background:

  • Congenital diaphragmatic hernia (CDH) presents a significant challenge in neonatal care.
  • Outcomes for infants with CDH have historically been variable.
  • A standardized management protocol, incorporating extracorporeal membrane oxygenation (ECMO), was implemented to address this challenge.

Purpose of the Study:

  • To evaluate the outcomes of newborns with CDH managed under a protocol.
  • To detail the components of a protocolized management strategy for CDH.
  • To assess the impact of extracorporeal membrane oxygenation (ECMO) within this protocol.

Main Methods:

  • Retrospective chart review of near-term newborns (>34 weeks' gestation) with CDH.
  • Protocol included antenatal assessment, steroids, planned delivery, prophylactic surfactant, gentle ventilation, permissive hypercarbia/hypoxia, and venovenous ECMO.

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  • Data collected on survival, need for ECMO, antenatal diagnosis, and timing of surgery.

    • Main Results:

    • Overall survival rate was 78% (51 of 65 infants).
    • Infants requiring ECMO had a 68% survival rate (26 of 38).
    • Antenatal diagnosis before 25 weeks' gestation was associated with a 60% survival rate; delayed surgery correlated with improved outcomes.

    Conclusions:

    • Protocolized management of CDH is associated with improved outcomes in high-risk infants.
    • Prospective trials are necessary to validate the benefits of individual protocol components.
    • Further research should compare outcomes in infants born in ECMO centers versus other tertiary units.