title: Congenital diaphragmatic hernia: a survey of practice in Scandinavia.
abstract: There is no consensus on the treatment of congenital diaphragmatic hernia (CDH), and practice seems to vary between centres. The main purpose of the present study was to survey current practice in Scandinavia. Thirteen paediatric surgical centres serving a population of about 22 million were invited, and all participated. One questionnaire was completed at each centre. The questionnaire evaluated management following prenatal diagnosis, intensive care strategies, operative treatment, and long-term follow-up. Survival data (1995-1998) were available from 12 of 13 centres. Following prenatal diagnosis of CDH, vaginal delivery and maternal steroids were used at eight and six centres, respectively. All centres used high-frequency oscillation ventilation (HFOV), nitric oxide (NO), and surfactant comparatively often. Five centres had extracorporeal membrane oxygenation (ECMO) facilities, and four centres transferred ECMO candidates. The majority of centres (7/9) always tried HFOV before ECMO was instituted. Surgery was performed when the neonate was clinically stable (11/13) and when no signs of pulmonary hypertension were detected by echo-Doppler (6/13). The repair was performed by laparotomy at all centres and most commonly with nonabsorbable sutures (8/13). Thoracic drain was used routinely at seven centres. Long-term follow-up at a paediatric surgical centre was uncommon (3/13). Only three centres treated more than five CDH patients per year. Comparing survival in centres treating more than five with those treating five or fewer CDH patients per year, there was a tendency towards better survival in the higher-volume centres (72.4%) than in the centres with lower volume (58.7%), p =0.065.
authors.affiliation: Section of Paediatric Surgery, Rikshospitalet University Hospital, N-0027 Oslo, Norway.
authors.forename: Hans
authors.initials: H
authors.lastname: Skari
authors.forename: Kristin
authors.initials: K
authors.lastname: Bjornland
authors.forename: Bjorn
authors.initials: B
authors.lastname: Frenckner
authors.forename: Lars Goran
authors.initials: LG
authors.lastname: Friberg
authors.forename: Marja
authors.initials: M
authors.lastname: Heikkinen
authors.forename: Timo
authors.initials: T
authors.lastname: Hurme
authors.forename: Borger
authors.initials: B
authors.lastname: Loe
authors.forename: Gunnhild
authors.initials: G
authors.lastname: Mollerlokken
authors.forename: Ole Henrik
authors.initials: OH
authors.lastname: Nielsen
authors.forename: Niels
authors.initials: N
authors.lastname: Qvist
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
authors.forename: Katarina
authors.initials: K
authors.lastname: Sandgren
authors.forename: Willy
authors.initials: W
authors.lastname: Serlo
authors.forename: Kari
authors.initials: K
authors.lastname: Wagner
authors.forename: Tomas
authors.initials: T
authors.lastname: Wester
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Emblem
mesh_terms: D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation / Q000706:statistics & numerical data; D006801:Humans; D010818:Practice Patterns, Physicians'; D012537:Scandinavian and Nordic Countries