OUTCOME FOR INFANTS WITH CONGENITAL DIAPHRAGMATIC-HERNIA REQUIRING EXTRACORPOREAL MEMBRANE-OXYGENATION - THE FIRST YEAR

Congenital diaphragmatic hernia (CDH) has been associated with a high mortality rate. The purposes of this study were to determine the impac t of extracorporeal membrane oxygenation (ECMO) on the survival of inf ants with CDH and to document the sequelae and 1-year neurodevelopment al outcome for CDH infants who required ECMO. Thirty neonates with CDH were admitted between May 7, 1990 and October 1, 1992. Twenty require d ECMO and were enrolled in our neonatal follow-up program. Informatio n about the infants' neonatal course was obtained from chart review, a nd the infants were seen at 3, 6, and 12 months of age for medical and neurodevelopmental follow-up. Primary diaphragmatic repair was perfor med in 13 infants. Five required Goretex graft reconstruction (GGR), a nd two did not have repair. Sixteen (80%) of the 20 infants who requir ed ECMO survived. The overall survival rate increased from 31% (10 of 32) in the 5 years previous to the start of the ECMO program to 63% (1 9 of 30) since then (P = .01). The most common sequelae noted by the t ime of discharge included gastroesophageal reflux (GER; 81%), the need for tube feeding (69%), and chronic lung disease (CLD; 62%). At 1 yea r of age, mean cognitive skills were average (87 +/- 23) and motor ski lls were borderline (75 +/- 24) according to the Bayley Scales of Infa nt Development. Hypotonia was present in 10 of 13 patients. GER remain ed in 6 of 13 and CLD in 3 of 13. There were differences in the mean c ognitive (65 +/- 28 v 97 +/- 13; P = .07) and motor skills (51 +/- 3 v 85 +/- 21; P = .01) between infants requiring (GGR) and those in whom primary reduction was possible. Furthermore, those with GGR required significantly prolonged durations of ECMO bypass, mechanical ventilati on, oxygen therapy, sedation, hospitalization, and tube feedings. Thes e results suggest that ECMO improved survival for infants with CDH; ho wever, sequelae were frequently seen. At 1 year of age, those with the largest diaphragmatic defects fared worse than those with smaller def ects. Copyright (C) 1995 by W.B. Saunders Company