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Experience in the Management of Eighty-Two Newborns With Congenital Diaphragmatic Hernia Treated With High-Frequency Oscillatory Ventilation and Delayed Surgery Without the Use of Extracorporeal Membrane Oxygenation

Service de réanimation néonatale, Universite Paris-Descartes

Elizabeth Walter-Nicolet, MD

Service de réanimation néonatale, Universite Paris-Descartes

Véronique Rousseau, MD

Service de chirurgie pédiatrique, Universite Paris-Descartes

Pierre Taupin, MD

Unité de biostatistiques et informatique médicale, Universite Paris-Descartes

Alexandra Benachi, MD, PhD

Unite de Maternité, Université Paris-Descartes, Faculté de Médecine AP-HP, Hôpital Necker-Enfants Malades, Paris, France

Sophie Parat, MD

Unite de Maternité, Université Paris-Descartes, Faculté de Médecine AP-HP, Hôpital Necker-Enfants Malades, Paris, France

Philippe Hubert, MD

Service de réanimation néonatale, Universite Paris-Descartes

Yan Revillon, MD

Service de chirurgie pédiatrique, Universite Paris-Descartes

Delphine Mitanchez, MD, PhD

Service de réanimation néonatale, Universite Paris-Descartes, mitanchez{at}trs.ap-hop-paris.fr

The aim of this study is to analyze neonatal outcome of isolated congenital diaphragmatic hernia and to identify prenatal and postnatal prognosis-related factors. A retrospective single institution series from January 2000 to November 2005 of isolated congenital diaphragmatic hernia neonates was reviewed. Respiratory-care strategy was early high-frequency oscillatory ventilation, nitric oxide in pulmonary hypertension, and delayed surgery after respiratory and hemodynamic stabilization. Survival rate at 1 month was 65.9%. None of the prenatal factors were predictive of neonatal outcome, except an intra-abdominal stomach in left diaphragmatic hernia. Preoperative pulmonary hypertension was more severe in the nonsurvivor group and was predictive of length of ventilation in the survivors. During the first 48 hours of life, the best oxygenation index above 13 and the best PaCO₂ above 45 were predictive of poor outcome. When treating isolated congenital diaphragmatic hernia with early high-frequency ventilation and delayed surgery but excluding extracorporeal membrane oxygenation, survival rates compare favorably with other reported series, and the respiratory morbidity is low.

Key Words: congenital diaphragmatic hernia (CDH) • high-frequency oscillatory ventilation (HFOV) • pulmonary hypertension • pleural effusion • prenatal diagnosis

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