The western Canadian experience with congenital diaphragmatic hernia: perinatal factors predictive of extracorporeal membrane oxygenation and death

Pediatric Surgery International
C SreenanH Osiovich

Abstract

This study documents how congenital diaphragmatic hernia (CDH) is managed in level III neonatal intensive care units (NICUs) in western Canada and examines perinatal factors predictive of the need for extracorporeal membrane oxygenation (ECMO). Information was obtained retrospectively from all level III NICUs in western Canada about the management of infants with CDH between 1992 and 1996; 91 infants with isolated CDH were identified. A prenatal diagnosis was made in 42 cases (46%). Surfactant was used in 53%, high-frequency oscillation (HFO) in 29%, and nitric oxide (NO) in 27%. Of the 69 infants born in referral centers, 29 (42%) were referred for possible ECMO; 17 (59%) of those required ECMO, with 65% survival. The overall requirement for ECMO was 30%. Death or ECMO occurred in 40% of cases overall. Overall survival was 82%. Survival in those needing ECMO was 74%, and in those not needing ECMO 86%. Significant predictors of death or ECMO were: prenatal diagnosis (P < 0.05), maximum postductal arterial partial pressure of oxygen (PaO2) < 100 mmHg (P < 0.001), and an oxygenation index (OI) at 6 h > 15 (P < 0.001). In cases where there is a prenatal diagnosis of CDH the mother should deliver at an ECMO center. Alternatively, a...Continue Reading

Citations

Nov 2, 2007·Pediatric Surgery International·Geraldine Yin Taeng NgSandra Adamson Calvert
Mar 31, 2004·Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie·C FlamantS Renolleau
Jan 23, 2003·The Annals of Thoracic Surgery·Sophie M JaillardLaurent Storme
Mar 6, 2004·Seminars in Neonatology : SN·Cynthia D Downard, Jay M Wilson
Apr 28, 2007·Seminars in Pediatric Surgery·Matthew T Harting, Kevin P Lally
Mar 6, 2007·Journal of Pediatric Surgery·Cynthia M SchultzUNKNOWN Congenital Diaphragmatic Hernia Study Group
Jun 14, 2008·Prenatal Diagnosis·Priscilla Chiu, Holly L Hedrick
Apr 18, 2006·Early Human Development·Andrea F Conforti, Paul D Losty
Feb 13, 2004·Journal of Perinatology : Official Journal of the California Perinatal Association·Matthew SebaldIstvan Seri
Mar 13, 2014·Journal of Paediatrics and Child Health·Sara MayfieldAndreas Schibler
May 25, 2004·Pediatric Surgery International·Hans SkariRagnhild Emblem
Jul 14, 2010·Journal of Pediatric Surgery·Juan E SolaLeonidas G Koniaris

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