Presented at the Neonatal Society 2004 Autumn Meeting.
Ng GYT1, Lucas C1, Marston L2, Calvert SA1 (introduced by Dr S Calvert)
1 Department of Neonatology, St George’s Hospital, London, UK
2 Department of Community Health Sciences, St George’s Hospital Medical School, London, UK
Objective: To compare the survival rates for 2 therapeutic eras, each using different treatment strategies, for the management of newborn infants with congenital diaphragmatic hernia (CDH).
Methods: A retrospective case review of 57 infants born between 1991 and 2004 with CDH from a single Tertiary Care perinatal centre in the United Kingdom from 1991 to 2004. Elective conventional mechanical ventilation (CMV) and systemic vasodilators were used from 1991 to 1995 (Era 1). Elective high frequency oscillatory ventilation (HFOV) and nitric oxide (NO) was used between 1996 and 2004 (Era 2). Main outcome measures were survival and incidence of chronic lung disease (oxygen dependence at 28 days).
Results: The survival rate was 38% (8/21) in Era 1 and 67% (24/36) in Era 2 95% CI for difference – 0.54 to -0.03 The incidence of chronic lung disease in survivors was 45% (5/11) in Era 1 and 31% (8/26) in Era 2, 95% CI for difference -0.20 to 0.49. Survival rates were significantly higher for males than females.
Conclusion: These data show significantly improved survival with elective use of HFOV and NO compared to CMV and systemic vasodilators. The survival results for CDH at St George’s Hospital are comparable to those published from other institutions. CDH is associated with significant mortality and morbidity.