CONGENITAL DIAPHRAGMATIC-HERNIA SURVIVAL AND USE OF EXTRACORPOREAL LIFE-SUPPORT AT SELECTED LEVEL-III NURSERIES WITH MULTIMODALITY SUPPORT

Background. Congenital diaphragmatic hernia (CDH) has been cited to ha ve a mortality rate of 50%. There have been multiple studies at indivi dual institutions demonstrating potential benefits from various strate gies including extracorporeal life support (ECLS), delayed repair and lower levels of ventilator support. There has been no multicenter surv ey of institutions offering-these modalities to describe the cuv rent use of ECLS and survival of these infants. In addition, the relationsh ip between the number of patients with CDH managed at an individual in stitution and outcome has not been evaluated. Methods. We queried 16 l evel III neonatal intensive care centers on the use of ECLS and surviv al of infants with CDU who were treated during 2 consecutive years (19 93 to 1995). Darn are presented as mean +/- SEM median, and range. Res ults. Data were collected on 411 patients Of these, 71% +/- 8% were ou tborn and 8% +/- 3% were considered nonviable. Overall survival of CDH infants was 69% +/- 4% (range, 39% to 95%). The survival rate of infa nts on ECLS was 55% +/- 4%, whereas survival ofinfants nor requiring E CLS was significantly increased at 81% +/- 5% (p = 0.005). The mean ra te of ECLS use was 46% +/- 2%. There was no correlation between the nu mber of cases per rear at an individual institution and overall surviv al, ECLS survival, or ECLS use (r = 0.341, 0.305, and 0.287, respectiv ely). There was also no correlation between case volume at an. individ ual institution and ECLS survival (r = 0.271). Conclusions. The curren t survival rate and rate of ECLS use in infants with CDH at level III neonatal intensive care units in the United States are 69% +/- 4% and 46% +/- 2%, respectively. There is no correlation between the yearly i ndividual center experience with managing CDH and rate of ECLS use or outcome.