title: Is delayed surgery really better for congenital diaphragmatic hernia?: a prospective randomized clinical trial.
abstract: Delayed surgery has become widely accepted in the management of congenital diaphragmatic hernia after comparing outcomes only with historical retrospective controls. It was the aim of this study to compare early and delayed hernia repair in a randomized prospective clinical trial. Fifty-four infants were randomized to receive either early repair (within 4 hours of admission) or delayed repair (more than 24 hours after birth). The survival rate was higher for the delayed group (57% v 46%), but the difference was not significant (difference: -11; 95% confidence limits: -37.5, 15.5). There were no significant differences between the two groups with respect to length of hospital stay, ventilator dependency, or survival time. Recorded preoperative risk factors were similar for the two groups. Eight infants in the delayed repair group died without having undergone surgery. The optimum time for surgery still needs clarification.
authors.affiliation: Department of Paediatric Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, England.
authors.forename: M N
authors.initials: MN
authors.lastname: de la Hunt
authors.forename: N
authors.initials: N
authors.lastname: Madden
authors.forename: J E
authors.initials: JE
authors.lastname: Scott
authors.forename: J N
authors.initials: JN
authors.lastname: Matthews
authors.forename: J
authors.initials: J
authors.lastname: Beck
authors.forename: C
authors.initials: C
authors.lastname: Sadler
authors.forename: A M
authors.initials: AM
authors.lastname: Barrett
authors.forename: S A
authors.initials: SA
authors.lastname: Boddy
authors.forename: R J
authors.initials: RJ
authors.lastname: Bray
authors.forename: E
authors.initials: E
authors.lastname: Cusick
authors.forename: L
authors.initials: L
authors.lastname: Gardner
authors.forename: S A
authors.initials: SA
authors.lastname: Hargrave
authors.forename: W
authors.initials: W
authors.lastname: Hinton
authors.forename: L
authors.initials: L
authors.lastname: Rangecroft
authors.forename: R
authors.initials: R
authors.lastname: Spicer
authors.forename: M
authors.initials: M
authors.lastname: Stafford
authors.forename: D
authors.initials: D
authors.lastname: Thomas
authors.forename: C J
authors.initials: CJ
authors.lastname: Vallis
authors.forename: J
authors.initials: J
authors.lastname: Wagget
mesh_terms: D001784:Blood Gas Analysis; D004739:England / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008168:Lung / Q000002:abnormalities; D011446:Prospective Studies; D012121:Respiration, Artificial; D015996:Survival Rate; D013997:Time Factors