EFFECT OF VERY DELAYED REPAIR OF CONGENITAL DIAPHRAGMATIC-HERNIA ON SURVIVAL AND EXTRACORPOREAL LIFE-SUPPORT USE

Background. Since November 1992, operative repair in neonates with con genital diaphragmatic hernia (CDH) at this institution was delayed unt il respiratory insufficiency had resolved. Methods. A retrospective an alysis was performed (n = 33) comparing delayed repair with our previo usly reported institutional experience with immediate repair from Janu ary 1988 to October 1992 (n = 66). Infants with severe genetic defects or moribund conditions or who were premature were not considered cand idates for repair or extracorporeal life support (ECLS), but they were included in the survival analysis. Survival was defined as hospital d ischarge. Data were compared with an independent t test or Pearson chi -squared test. Results. Mean age at repair was 8.9 +/- 4.5 days (range , 3 to 20 days). Eleven infants in the study group were placed on ECLS (33% versus 68% in the comparison group; p = 0.001). Six of these inf ants survived (55% versus 58% in the comparison group; p = 0.846). Of these survivors, one patient was repaired while on ECLS, and the remai nder underwent repair after decannulation from ECLS. All 20 of the rem aining candidates for repair survived without need for ECLS. Overall s urvival was 79% versus 56% in the comparison group (p = 0.027). Conclu sions. Our current data suggest that very delayed repair of newborns w ith CDHs is associated with an increase in the overall survival and a decrease in the use of ECLS wizen compared with previous experience at this institution.