Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization
Section snippets
Patients and methods
From October 1994 to June 2005, 111 neonates (69 male and 42 female infants) with CDH were admitted to the NICU of Bergamo's Ospedali Riuniti. Their clinical charts were retrospectively evaluated. All CDH newborns were included, except those transferred postoperatively.
All inborn and outborn infants with CDH at arrival were treated with the same protocol. If a prenatal diagnosis was made, a cesarean delivery was scheduled at term of the gestation. In case of preterm delivery, that is, before
General characteristics and findings
Seventy-five infants with CDH (67.6%) were born at our hospital. Among the inborn patients the survival was 62.6% (47/75) compared to 83.3% (30/36) among outborns (P = .027). Outborn patients were admitted after a mean of 48 hours (range, 1-840 hours) of life. Prenatal diagnosis was made in 68 (61.3%) patients: 43 (63.2%) of 68 infants were diagnosed before the 25th week of gestation and 23 (53.5%) of these 43 patients died (Table 1). Mean gestation age at birth of the whole series was 37.6 ±
Discussion
The present study reports an overall 69.4% survival rate in a large cohort of patients with CDH, with only 2 infants diagnosed late after birth. These results compare favorably with other reported series (53%-78%) [1], [4]. Mortality in inborn patients was significantly higher compared to outborns (37% vs 16%). This may reflect a “hidden mortality” before transfer in outborns: survivors had less severe pulmonary hypoplasia and absence of lethal associated anomalies, as suggested by Boloker et
Acknowledgments
We are grateful to Professor Max R. Langham Jr, Professor of Surgery and Pediatrics, Chief, Division of Pediatric Surgery, University of Tennessee, Memphis (USA), for his suggestions and advice while reviewing the manuscript.
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