Evolution of diaphragmatic hernia management in the years 1991 - 2002.
OBJECTIVE
Aim of the study was the analysis of our experience in the management of severe forms of CDH over the past 12 years. A comparison was made of pre- and postoperative strategy, with special attention focused on pharmacotherapy and respiratory therapy.


METHODS
Between 1991 and 2002, a total of 43 newborns with CDH were treated, 24 (55.8 %) boys and 19 (44.2 %) girls. When evaluating the methods and results, the 12-year period was subdivided into two 6-year intervals. The correlation between mortality rates in particular groups was studied together with such parameters as gestational age, birth weight, hernial contents, the timing of surgery, persistent pulmonary hypertension and the type of preoperative management.


RESULTS
A significant difference was noted in outcome in both groups. In the second 6-year period, the total mortality rate decreased from 59 % to less than 29 % compared to the first period (p < 0.05). Markedly higher mortality rates were seen in the subgroup of patients, in whom the hernia contained the stomach/liver tissue (62 % and 37 % in both respective periods).


CONCLUSIONS
Most likely, the change in the outcome can be ascribed to the evolution of management in recent years. Thanks to a thorough preparation for surgery, aggressive pharmacotherapy and sophisticated methods of respiratory support, it has been possible to significantly decrease mortality rates in children with CDH.
Bysiek
A
A
Department of Paediatric Surgery, Children's Hospital, Jagiellonian University, Kraków, Poland. a.bysiek@chello.pl
Zajac
A
A
Budzyńska
J
J
Bogusz
B
B
D005260:Female; D006548:Hernia, Diaphragmatic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies