The outcome in newborns with congenital diaphragmatic hernia in a Norwegian region.
OBJECTIVE
To evaluate the therapeutic strategies used in neonates with congenital diaphragmatic hernia (CDH) during the last 15 years in our department.


METHODS
A retrospective study of 27 neonates with CDH treated at the Neonatal Intensive Care Unit at Ullevaal University Hospital between 1992 and 2006. Since 1992 we have used delayed operative repair and high-frequency ventilation (HFV). Because surfactant replacement and inhaled nitric oxide (iNO) therapy have been used since 1997, we divided the patients into two groups; group 1 from 1992 to 1996 (9 patients) and group 2 from 1997 to 2006 (18 patients).


RESULTS
The overall survival was 70%. Group 1 had an exceptionally good outcome, 100% survival versus 56% in the last group.


CONCLUSIONS
Pulmonary hypoplasia and pulmonary hypertension are still the most challenging factors in treatment of neonates with CDH, despite novel therapeutic modalities, such as HFV, surfactant and iNO. Delayed surgery in CDH allows pre-operative stabilization. Extracorporeal membrane oxygenation must be considered in the most severe cases.
Fredly
S
S
Department of Paediatrics, Ullevaal University Hospital, Oslo, Norway. siv.fredly@uus.no
Aksnes
G
G
Viddal
K O
KO
Lindemann
R
R
Fugelseth
D
D
D000280:Administration, Inhalation; D001034:Apgar Score; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006612:High-Frequency Ventilation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D009569:Nitric Oxide