ABSTRACT
Despite many advances in the management of congenital diaphragmatic hernia (CDH),
the condition carries a mortality rate of 40-50% usually consequent to pulmonary hypoplasia
and/or persistent pulmonary hypertension. Several centers have reported improved survival
with preoperative stabilization and delayed surgery, which is now an accepted method
of management. This is a retrospective analysis of all neo-nates with respiratory
distress at birth due to CDH who were treated at our institution with neither extracorporeal
membrane oxygenation nor nitric oxide being used. The medical records of all neonates
with CDH and respiratory distress at birth who were treated at this institution from
August 1, 1992 through March 1, 1997 were reviewed. There were 21 patients, 11 male
and 10 female. There were 17 full-term and 4 premature infants; two premature infants
at 30 and 34 weeks' gestation were not resuscitated because of severe associated congenital
anomalies. Surgery was performed from 5 to 144 hr (mean 45 hr) in 18 infants. One
infant died during preoperative stabilization from severe pulmonary hypoplasia and
pulmonary hypertension and one infant died postoperatively from the same conditions.
Seventeen of 19 infants (89.5%) survived and were discharged home. Three infants (17.6%)
who failed to thrive due to severe gastroesophageal reflux (GER) required fundoplication.
Eleven infants (64.7%) who had sepsis proven by blood culture responded satisfactorily
to appropriate antibiotics. Preoperative stabilization and delayed surgery has been
a satisfactory form of management in our series. The significant complication was
sepsis, which must be addressed.
Keywords
Congenital diaphragmatic hernia - delayed surgery - extracorporeal membrane oxygenation
- nitric oxide - gastroesophageal reflux - sepsis
