Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization.
OBJECTIVE
No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient's circulatory stabilization (CS) was achieved.


METHODS
This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T, <0.10) was further investigated in both groups.


RESULTS
The overall survival rate (SR) was 93.8% in the GV + CS group and 59.1% in the FS group, respectively (P = 0.04). For the patients with the lower L/T, the SR was 85.7% in GV + CS group and 53.8% in the FS group (P = 0.33). Regarding the patients using a patch and liver-up, the SR in GV + CS group was better than that in the FS group (patch: FS 44.4%, GV +/- CS 87.5%, P = 0.18; liver-up: FS 57.8 and 87.5%, P = 0.30).


CONCLUSIONS
Our strategy of using GV +/- CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients.
Masumoto
Kouji
K
Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. kmasu@pedsurg.med.kyushu-u.ac.jp
Teshiba
Risa
R
Esumi
Genshiro
G
Nagata
Kouji
K
Takahata
Yasushi
Y
Hikino
Shunji
S
Hara
Toshiro
T
Hojo
Satoshi
S
Tsukimori
Kiyomi
K
Wake
Norio
N
Kinukawa
Naoko
N
Taguchi
Tomoaki
T
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002319:Cardiovascular System / Q000187:drug effects; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012121:Respiration, Artificial; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D002317:Cardiovascular Agents; D004280:Dobutamine; D004298:Dopamine