CONGENITAL DIAPHRAGMATIC-HERNIA - INCREAS E OF SURVIVAL USING ADVANCED VENTILATION TECHNIQUES AND PREOPERATIVE STABILIZATION

From October 1994 through May 1997 newborn infants with congenital dia phragmatic hernia (CDH) were treated at our hospital with high frequen cy oscillatory ventilation (HFOV) as a primary modality of ventilation and delayed surgery; the aim was to prevent iatrogenic lung injury an d to perform operation on infants with a more stabilized pulmonary vas cular bed. Results were compared with our previous experience and infa nts were divided into 2 chronological groups: group 1, consisting of 1 3 term symptomatic newborns with isolated CDH treated from November 19 91 through September 1994 with conventional ventilation and operation in the first hours of life; group 2, comprising 18 similar CDH infants treated with the new management protocol. The 2 groups did not differ significantly in birth weight and gestational age. Age at repair was 17.08 +/- 13.03 hours in group 1 and 55.69 +/- 27.93 hours in group 2 (p = 0.0001). In the last 13 cases surgery was performed in the neonat al intensive care unit. Preoperative and postoperative pH, PaO2, SaO2, oxygenation index AaDO2 and preoperative PaCO2 were significantly imp roved in infants of group 2. Extracorporeal membrane oxygenation (ECMO ) was used in one infant of group 1, who died, and in 2 infants of gro up 2, both survived. Group 2 showed a higher survival rate (83% versus 61%) and a shorter hospital stay. Management of infants with CDH is s till in evolution and there is not agreement about the optimal strateg y; treatment with a conservative pulmonary management using early HFOV as a primary modality of ventilation, eventually inhaled nitric oxide or ECMO and preoperative stabilization allowed us to improve the outc ome of our population of CDH infants.