CONGENITAL DIAPHRAGMATIC-HERNIA - LONG-TERM OUTCOME IN NEONATES TREATED WITH EXTRACORPOREAL MEMBRANE-OXYGENATION

As more infants with congenital diaphragmatic hernia (CDH) survive wit h extracorporeal membrane oxygenation (ECMO), it seems prudent to deta il the long-term outcome in these medically complex infants. Eighteen children with CDH treated with postoperative ECMO were recruited for p articipation in this study. The mean duration of ECMO was 193 hours (r ange 82 to 493 hours), mean time to extubation after ECMO was 142 hour s (range 34 to 312 hours), and median duration of hospitalization was 46 days (range 30 to 181 days). Of the 18 infants, 4 (22%) were discha rged home requiring oxygen therapy. At follow-up the notable findings were a high incidence of gastroesophageal reflux and failure to thrive . At both 1 and 2 years of age, 50% of infants were at less than the 5 th percentile for weight. At 1 and 2 years of age, 39% and 21%, respec tively, were at less than the Sth percentile for weight/length ratio. A total of 16 children (89%) had clinical evidence of reflux, and 8 (4 4%) were discharged home on a regimen of nasogastric feedings. Reherni ation occurred in 4 children (22%) and was more frequent when a patch was used. An electrocardiogram showed right ventricular hypertrophy in 6 (43%); oxygen saturation by pulse oximetry was >95% in all children , and pulmonary artery pressure was estimated by Doppler echocardiogra phy to be normal in 12 of 14 children examined. The neurodevelopmental outcome (Bayley Scales or Stanford-Binet scale) at 1 to 4 years of ag e was not dissimilar from that of other ECMO-treated children. Given t he severity of illness in the neonatal period, the general health and development of children with CDH surviving after ECMO are good. Surpri singly few children have long-term respiratory complications related t o pulmonary hypoplasia. Follow-up in the first few years should be aim ed at aggressive nutritional intervention to prevent the growth failur e that appears to be prevalent in these children.