The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia.
OBJECTIVE
Although the prognosis of congenital diaphragmatic hernia (CDH) is determined by the degree of pulmonary hypoplasia, there may be an occult contribution of infection to outcomes. The purpose of this study is to evaluate the effects of our new supportive therapy to prevent infectious complications on mortality and morbidity of CDH.


METHODS
Among 57 cases with CDH treated between 2002 and 2007, 43 prenatally diagnosed isolated cases were enrolled in this study. All patients were managed by a lung-protective strategy and delayed surgery. Since January 2006, we have optimized our perioperative care to reduce infectious complications by using peripherally inserted central catheters and restriction of invasive procedures including extracorporeal membranous oxygenation (ECMO). The survival rate, intubation period, maximum serum C-reactive protein (CRP) level, and complications were compared before and after the introduction of refined supportive therapy.


RESULTS
There were 25 cases (12 liver-up, 13 liver-down) treated before 2006 and 18 cases (8 liver-up, 10 liver-down) after 2006. ECMO was required for stabilization in five cases before 2006. The survival rates of total, liver-up, and liver-down cases improved from 60, 42, 77, to 83, 63, 100% after 2006, respectively. The intubation period was shortened from 37.8 +/- 24.3 to 22.2 +/- 10.8 days, and the maximum serum CRP level declined from 12.8 +/- 11.5 to 2.2 +/- 1.6 mg/dl after 2006. Nine cases developed sepsis before 2006 whereas no patients suffered from sepsis or pneumonia after 2006.


CONCLUSIONS
The new supportive therapy with strict infection control improved survival rate of prenatally diagnosed CDH without using ECMO.
Morikawa
Nobuyuki
N
Division of General Surgery, National Center For Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan. morikawa-n@ncchd.go.jp
Kuroda
Tatsuo
T
Honna
Toshiro
T
Kitano
Yoshihiro
Y
Takayasu
Hajime
H
Ito
Yushi
Y
Nakamura
Tomoo
T
Nakagawa
Satoshi
S
Hayashi
Satoshi
S
Sago
Haruhiko
H
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D002780:Cholestasis, Intrahepatic / Q000473:pathology; D004363:Drug Utilization / Q000639:trends; D004750:Enteral Nutrition; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D009020:Morphine / Q000627:therapeutic use; D011014:Pneumonia / Q000517:prevention & control*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D018805:Sepsis / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000473:pathology
D000701:Analgesics, Opioid; D000900:Anti-Bacterial Agents; D009020:Morphine; D002097:C-Reactive Protein