Effect of very delayed repair of congenital diaphragmatic hernia on survival and extracorporeal life support use.
BACKGROUND
Since November 1992, operative repair in neonates with congenital diaphragmatic hernia (CDH) at this institution was delayed until respiratory insufficiency had resolved.


METHODS
A retrospective analysis was performed (n = 33) comparing delayed repair with our previously reported institutional experience with immediate repair from January 1988 to October 1992 (n = 66). Infants with severe genetic defects or moribund conditions or who were premature were not considered candidates for repair or extracorporeal life support (ECLS), but they were included in the survival analysis. Survival was defined as hospital discharge. Data were compared with an independent t test or Pearson chi-squared test.


RESULTS
Mean age at repair was 8.9 +/- 4.5 days (range, 3 to 20 days). Eleven infants in the study group were placed on ECLS (33% versus 68% in the comparison group; p = 0.001). Six of these infants survived (55% versus 58% in the comparison group; p = 0.846). Of these survivors, one patient was repaired while on ECLS, and the remainder underwent repair after decannulation from ECLS. All 20 of the remaining candidates for repair survived without need for ECLS. Overall survival was 79% versus 56% in the comparison group (p = 0.027).


CONCLUSIONS
Our current data suggest that very delayed repair of newborns with CDHs is associated with an increase in the overall survival and a decrease in the use of ECLS when compared with previous experience at this institution.
Reickert
C A
CA
University of Michigan Medical Center, Ann Arbor, Detroit, USA.
Hirschl
R B
RB
Schumacher
R
R
Geiger
J D
JD
Cox
C
C
Teitelbaum
D H
DH
Polley
T Z
TZ
Harmon
C M
CM
Lelli
J L
JL
Coran
A G
AG
D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000401:mortality* / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors