Long-term outcome following extracorporeal membrane oxygenation for congenital diaphragmatic hernia: the UK experience.
OBJECTIVE
We evaluated the long-term outcome of neonates receiving extracorporeal membrane oxygenation (ECMO) for congenital diaphragmatic hernia (CDH). Study design A retrospective review of all 73 neonates with CDH supported with ECMO in the United Kingdom between 1991 and 2000, with follow-up to January 2003. Information was from hospital charts and from communication with family doctors and pediatricians. Median follow-up period for survivors was 67 months.


RESULTS
46 infants (63%) were weaned from ECMO, 42 (58%) survived to hospital discharge, and 27 (37%) survived to age 1 year or more. A higher birth weight, higher 5-minute Apgar score, and postnatal diagnosis were "pre-ECMO" predictors of long-term survival. Comorbidity was common in long-term survivors: 13 (48%) had respiratory symptoms, 16(59%) had gastrointestinal problems, and 6 (19%) had severe neurodevelopmental problems. Only 7 children were free of significant neurodevelopmental deficit and required no further medical or surgical intervention.


CONCLUSIONS
Using the current referral criteria, ECMO can be used to support the sickest neonates with CDH. However, there is significant mortality in the first year of life, and long-term physical and neurodevelopmental morbidity remains in the majority of survivors.
Heartlink ECMO Centre, Glenfield Hospital, and the Department of Epidemiology, University of Leicester, Leicester, United Kingdom.
Peter J
PJ
Davis
Richard K
RK
Firmin
Brad
B
Manktelow
Allan P
AP
Goldman
Carl F
CF
Davis
Jon H
JH
Smith
Jane V
JV
Cassidy
Lara S
LS
Shekerdemian
D001034:Apgar Score; D001724:Birth Weight; D002423:Cause of Death; D015897:Comorbidity; D002658:Developmental Disabilities / Q000209:etiology; D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000401:mortality* / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D012189:Retrospective Studies; D016019:Survival Analysis