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. 2026 Mar 13.
doi: 10.1038/s41372-026-02605-0. Online ahead of print.

Congenital diaphragmatic hernia: are improvements in ECMO & survival sustainable over time?

Michelle J Yang  1   2 , Ryan J Carpenter  3   4   5 , Christian C Yost  3   4   6 , Anastasia M Kahan  4   7 , Stephen J Fenton  4   7 , Katie W Russell  4   7 , Bradley A Yoder  3   4
Affiliations

Congenital diaphragmatic hernia: are improvements in ECMO & survival sustainable over time?

Michelle J Yang et al. J Perinatol. .

Abstract

Background: Infants with congenital diaphragmatic hernia (CDH) remain at high risk for ECMO and mortality. We previously reported improved outcomes after implementing new CDH care guidelines. This study reassesses ECMO rates, survival, and guideline adherence to determine if improvements persisted.

Methods: Retrospective review of all neonatal CDH cases at a single center during pre-guideline (2003-2015, n = 229) and post-guideline (2016-2024, n = 160) periods, with post-guideline subdivided into two epochs: post-1 (2016-2019, n = 70) and post-2 (2020-2024, n = 90).

Results: Survival without ECMO improved (pre-53%; post-1 74%; post-2 82%; p < 0.001), as did overall survival (72% vs. 83% vs. 86%; p = 0.006). ECMO use decreased (31% vs. 14% vs. 6%; p < 0.001). Inhaled nitric oxide use remained low, and vasoactive medication use dropped significantly in post-2.

Conclusion: Sustained survival improvement and reduced ECMO use followed guideline changes emphasizing minimal stimulation, gentle ventilation, delayed transfer, pre-ductal saturation monitoring, and limited vasoactive therapy.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval: All study methods were performed in accordance with the relevant guidelines and regulations, including institutional, national, and international research standards. Approval for this study was obtained from the University of Utah/Primary Children’s Hospital IRBs, under protocol IRB_00182610, which was determined to be exempt from full review. As part of this exempt determination, the Institutional Review Board granted a waiver of informed consent.

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