The western Canadian experience with congenital diaphragmatic hernia: perinatal factors predictive of extracorporeal membrane oxygenation and death

This study documents how congenital diaphragmatic hernia (CDH) is managed i n level III neonatal intensive care units (NICUs) in western Canada and exa mines perinatal factors predictive of the need for extracorporeal membrane oxygenation (ECMO), Information was obtained retrospectively from all level III NICUs in western Canada about the management of infants with CDH betwe en 1992 and 1996; 91 infants with isolated CDH were identified. A prenatal diagnosis was made in 42 cases (46%). Surfactant was used in 53%, high-freq uency oscillation (HFO) in 29%, and nitric oxide (NO) in 27%. Of the 69 inf ants born in referral centers, 29 (42%) were referred for possible ECMO; 17 (59%) of those required ECMO, with 65% survival. The overall requirement f or ECMO was 30%, Death or ECMO occurred in 40% of cases overall. Overall su rvival was 82%. Survival in those needing ECMO was 74%, and in those not ne eding ECMO 86%. Significant predictors of death or ECMO were: prenatal diag nosis (P < 0.05), maximum postductal arterial partial pressure of oxygen (P aO2) < 100 mmHg (P < 0.001), and an oxygenation index (OI) at 6 h > 15 (P < 0,001). In cases where there is a prenatal diagnosis of CDH the mother sho uld deliver at an ECMO center. Alternatively? an OI of >15 at 6 h and PaO2 < 100 mmHg should prompt referral to an ECMO center.