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.
Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Lira 85, Piso 5, Santiago, Chile. kattan@med.puc.cl
Javier
J
Kattan
Loreto
L
Godoy
Alejandro
A
Zavala
Miriam
M
Faunes
Pedro
P
Becker
Alberto
A
Estay
Jorge
J
Fabres
Paulina
P
Toso
Soledad
S
Urzúa
Jorge
J
Becker
Jaime
J
Cerda
Alvaro
A
González
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