Severe Congenital Diaphragmatic Hernia (CDH): A critical analysis of eight years' experience

Pietro Bagolan, G. Casaccia, A. Nahom, A. Trucchi, A. Zangari, R. Laviani, N. Pirozzi, G. Di Liso, M. Orzalesi

Research output: Contribution to journalArticle

Abstract

Objectives: 1) To define the best outcome of severe Congenital Diaphragmatic Hernia (CDH); 2) to critically evaluate deaths in order to identify possible criteria of exclusion from ECMO; and 3) to identify CDHs which could benefit from ECMO. Materials and Methods: 63 severe CDHs, 35 (55.6%) survivors and 28 (44.4%) nonsurvivors, subdivided into 2 groups according to age at death: Group I dying at 12 ≤ 24 hours, and Group II dying at > 24 hours after birth. The three groups were compared on the basis of prenatal diagnosis, polyhydramnios, gestational age, birth weight, pneumothorax, best values of postductal PaCO2 and PaO2, clinical and echocardiographic signs of persistent pulmonary hypertension, and severity of pulmonary hypoplasia (i.e., body weight to bilateral lung weight ratio at autopsy). Results: PaCO2, PaO2 and degree of pulmonary hypoplasia were significantly worse in Group I compared to Group II and to survivors. PaCO2 and PaO2 in Group II did not differ significantly from those of survivors. Conclusions: In severe CDH it is possible: 1) to achieve a survival rate of 56% without ECMO; 2) to identify a group of patients (Group 1 = 27%) with severe pulmonary hypoplasia who would probably die even with ECMO; and 3) to identify a group of patients (Group II = 17%) who might benefit from ECMO treatment.

Original languageEnglish
Pages (from-to)95-100
Number of pages6
JournalEuropean Journal of Pediatric Surgery
Volume12
Issue number2
DOIs
Publication statusPublished - 2002

Keywords

  • Congenital diaphragmatic hernia
  • ECMO
  • Pulmonary hypoplasia prediction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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