Severe congenital diaphragmatic hernia (CDH): a critical analysis of eight years' experience.
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.


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 < or = 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 PaCO 2 and PaO 2, 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
PaCO 2, PaO 2 and degree of pulmonary hypoplasia were significantly worse in Group I compared to Group II and to survivors. PaCO 2 and PaO 2 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 I = 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.
Bagolan
P
P
Neonatal Surgery Unit, Bambino Gesù Paediatric Hospital IRCCS, Rome, Italy. bagolan@opbg.net
Casaccia
G
G
Nahom
A
A
Trucchi
A
A
Zangari
A
A
Laviani
R
R
Pirozzi
N
N
Di Liso
G
G
Orzalesi
M
M
D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D016019:Survival Analysis