Abstract
Objective: Neonatal congenital diaphragmatic hernia (CDH) is one of the major congenital anomalies with high mortality rates. Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for CDH patients who do not respond to conventional ventilation strategies. The aim of this study is to compare the epochs before and after the introduction of neonatal ECMO program and to determine its impact on response and survival of neonates with isolated CDH.Materials and Methods: Admitted neonates with CDH patients since 2012 were separated into two epochs according to the establishment of ECMO: Pre-ECMO period (January 2012–August 2015) and ECMO period (September 2015–December 2017). The demographic, clinical, and surgical data of the patients were compared between these two periods.Results: During the study period, a total of 35 neonates with CDH were admitted. Patient characteristics and surgical data were similar in both groups. Need for high-frequency oscillatory ventilation (HFOV) was higher in the pre-ECMO period (P = 0.04). The length of hospitalization was longer in ECMO period (P = 0.01). Three among seven patients who received ECMO survived (43%). Survival rates at the time of discharge were similar in groups (39% vs. 47%, P = 0.625). It was demonstrated that having oxygenation index >40 at first 24 h (odds ratio (OR): 12, 95% Cl 2.37–60.64, P = 0.03) and the ratio of pulmonary artery pressure to systolic pressure > 1 (OR: 6, 95% Cl 1.33–27.04, P = 0.02) increased mortality.Conclusion: The establishment of neonatal ECMO program was not associated with an improvement in survival of isolated CDH patients. We suggest that better outcomes may be achieved with defining selective criteria for ECMO candidates.
Highlights
Congenital diaphragmatic hernia (CDH) is one of the major congenital anomalies with an incidence of 1 in 2500–3000 live births [1,2]
All newborns with CDH admitted to our neonatal intensive care unit (NICU) in the past 6 years were divided into two groups: Pre-extracorporeal membrane oxygenation (ECMO) period (January 2012–August 2015) and ECMO period (September 2015–December 2017)
There was no significant difference in patient characteristics with respect to gestational age (GA) (38 ± 1.8 w vs. 38.4 ± 1.6 w, P = 0.42), birth weight (BW) (2910 ± 546 g vs. 3030 ± 782 g, P = 0.6), gender (83% vs. 65%, P = 0.26), antenatal diagnosis rate (72% vs. 71%, P = 1.0), APGAR score at 5 min, side of lesion, and liver or stomach herniation
Summary
Congenital diaphragmatic hernia (CDH) is one of the major congenital anomalies with an incidence of 1 in 2500–3000 live births [1,2]. Despite advances in neonatal care and intensive efforts to improve outcomes for infants with CDH, the mortality remains high at approximately 30–40% [3,4,5]. Supportive treatments as inhaled nitric oxide (iNO), high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation (ECMO) followed by surgical repair after stabilization are the postnatal managements. ECMO is a rescue therapy for CDH patients who do not respond to conventional treatment modalities such as HFOV and iNO [8,9]. The first use of ECMO was reported by German et al in 1977 in four CDH patients, of whom only one survived [10]. Extracorporeal life support organization reports 50% survival for CDH patients which has not improved over the past few decades and remains same [13]
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