title: [Congenital diaphragmatic hernia. Value of preoperative stabilization].
abstract: Seventy-two patients with congenital diaphragmatic hernia (CDH) diagnosed in the first 12 hours of live have been reviewed retrospectively. Forty-eight patients born before 1985 (group I) were compared to 24 patients born between 1985 and 1989 (group II). The management was different for the 2 groups. Group I was operated on immediately. For group II, delayed surgery after stabilization was preferred. For this group, stability was sought before, during and after surgery. Therapy was first aimed at optimizing ventilation and oxygenation by way mechanical ventilation. Pharmacologic agents were used in an attempt to decrease pulmonary vascular resistance and improve cardiac output. The survival rate was 37.5% before 1985, 62.5% after 1985 (P less than 0.01). Main prognostic factors were Apgar score, paCO2, pH, ventilation index, alveolar-arterial difference in oxygen and oxygenation index. The stabilization before surgery improved the survival rate.
authors.affiliation: Service de réanimation pédiatrique polyvalente, hôpital Robert-Debré, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Casadevall
authors.forename: P
authors.initials: P
authors.lastname: Daoud
authors.forename: F
authors.initials: F
authors.lastname: Beaufils
authors.forename: Y
authors.initials: Y
authors.lastname: Aigrain
authors.forename: J C
authors.initials: JC
authors.lastname: Mercier
authors.forename: J F
authors.initials: JF
authors.lastname: Hartmann
mesh_terms: D002245:Carbon Dioxide / Q000032:analysis; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000032:analysis; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D012129:Respiratory Function Tests
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
vernacular_title: Hernie diaphragmatique congénitale. Intérêt d'une stabilisation préopératoire.