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Observational Study
. 2022 Sep;42(9):1189-1194.
doi: 10.1038/s41372-022-01397-3. Epub 2022 Apr 23.

Improved survival for infants with severe congenital diaphragmatic hernia

Jason Gien  1   2 , John P Kinsella  3   4 , Nicholas J Behrendt  4   5 , Michael V Zaretsky  4   5 , Henry L Galan  4   5 , Kenneth W Liechty  4   6
Affiliations
Observational Study

Improved survival for infants with severe congenital diaphragmatic hernia

Jason Gien et al. J Perinatol. 2022 Sep.

Abstract

Background: Survival for severe (observed to expected lung-head ratio (O:E LHR) < 25%) congenital diaphragmatic hernia (CDH) remains a challenge (15-25%). Management strategies have focused on fetal endoscopic tracheal occlusion (FETO) and/or extracorporeal membrane oxygenation therapy (ECMO) utilization.

Objective(s): Describe single center outcomes for infants with severe CDH.

Study design: Observational study of 13 severe CDH infants managed with ECMO, a protocolized DR algorithm, and early repair on ECMO with an innovative perioperative anticoagulation strategy.

Results: 13/140 (9.3%) infants met criteria and were managed with ECMO. 77% survived ECMO and 69% survived to discharge. 22% underwent tracheostomy. Median days on mechanical ventilation was 39 days (IQR 22:107.5) and length of stay 135 days (IQR 62.5:211.5). All infants received a gastrostomy tube (GT) and were discharged home on oxygen and pulmonary hypertension (PH) meds.

Conclusion: Survival for infants with severe CDH can be optimized with early aggressive intervention and protocolized algorithms (149).

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References

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