Objective: to evaluate 1 year outcome of newborn infants with congenital diaphragmatic hernia (CDH) managed with advanced therapies for respiratory failure. Methods: in a level III neonatal intensive care unit, 22 newborn infants with CDH without associated anomalies were treated with early high frequency oscillatory ventilation (HFOV) and delayed surgery. Infants unresponsive to HFOV were treated with surfactant, inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO) to achieve preoperative stabilisation. Results: 19 infants survived (86.3%) and undenvent clinical and neurodevelopmental follow-up. Data of 15 patients, 10 males and 5 females, are available at 1 year of age. All infans were treated with HFOV, 3 with surfactant, 3 with iNO, 1 with ECMO. Growth at 1 year was sligthly below the 10th centile infernales, between the 10th and the 50th centile in males. Gastro-esophageal reflux was present in 5 infants (33%); 6 infants (40%) were treated with procinetic drugs, none was feeded with orogastric tube. None was treated with oxygen at domicile. 1 infant was operated for recurrent diaphragmatic hernia at 75 months. Neurologic examination (Amiel-Tison and Grenier) showed transient anomalies (mild hypotonia, choreic movements of the extremities) at 6 months in 40% of infants, while a normal neurologic examination was present in 100% of patients at 1 year of age. The development quotient (Griffiths scale) was within normal values in 10 infants and showed mild anomalies in 2 (16%). Conclusion: a management based on early HFOV, eventually associated with surfactant, iNO and ECMO to achieve preoperative stabilization allowed us to obtain a survival rate of 86.3% and a good clinical and neurodevelopmental outcome at 1 year of age in infants with congenital diaphragmatic hernia. Further longitudinal follow-up is required in this high risk population of infants.
|Translated title of the contribution||1 year follow-up of infants with congenital diaphragmatic hernia|
|Number of pages||5|
|Journal||Rivista Italiana di Pediatria|
|Publication status||Published - 1999|
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health