Improvement of survival in infants with congenital diaphragmatic hernia in recent years: effect of ECMO availability and associated factors.
OBJECTIVE
Survival of patients with congenital diaphragmatic hernia (CDH) depends both on non-modifiable congenital conditions and on modifiable pre and postnatal management. ECMO improves survival up to 80% in neonates with CDH in the best ECMO centers worldwide. The first Neonatal ECMO Program in Chile was started in our University in 2003. Our objective is to determine the impact of a Neonatal ECMO Program in a level III NICU on newborns with CDH.


METHODS
Data of all newborns with CDH admitted to our NICU was separated into two groups: pre ECMO (1996-2003) and ECMO (2003-2007). Crude and adjusted odds ratios for 24 months survival were estimated by logistic regression.


RESULTS
Data of 46 newborns with CDH was analysed, 20 in the pre ECMO and 26 in the ECMO period. Patient characteristics were similar in both groups; however, 24-month survival increased significantly from 25% (5/20) in the pre ECMO period to 77% (20/26) in the ECMO period (P = 0.001). Adjusted odds ratios for 24-month survival were 26.98 for OI <or= 40, 7.58 for 5 min Apgar >or= 7 and 17.5 for ECMO availability.


CONCLUSIONS
The establishment of an ECMO program was associated with a significant increase in long-term survival for infants with CDH.
Kattan
Javier
J
Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Lira 85, Piso 5, Santiago, Chile. kattan@med.puc.cl
Godoy
Loreto
L
Zavala
Alejandro
A
Faunes
Miriam
M
Becker
Pedro
P
Estay
Alberto
A
Fabres
Jorge
J
Toso
Paulina
P
Urzúa
Soledad
S
Becker
Jorge
J
Cerda
Jaime
J
González
Alvaro
A
D002677:Chile; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015397:Program Evaluation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome