Protocolized management of infants with congenital diaphragmatic hernia: effect on survival.
OBJECTIVE
In 2006, we introduced a new protocol for congenital diaphragmatic hernia (CDH) management featuring nitric oxide in the delivery room, gentle ventilation, lower criteria for extracorporeal membrane oxygenation (ECMO), and appropriately timed operative repair on ECMO. Our goals were to assess outcomes after institution of this protocol and to compare results with historical controls.


METHODS
Charts were reviewed of all newborns admitted to a large metropolitan children's hospital from 2002 to 2009 with a diagnosis of CDH. Data were recorded regarding delivery, ECMO, operative repair, length of stay, comorbidities/anomalies, complications, and survival. Postprotocol outcomes were compared to those from the preprotocol era and to data from the international CDH Registry.


RESULTS
Comparison of the protocolized group (n = 43) to the historical group (n = 51) revealed no significant differences in gestational age, birth weight, Apgar scores, or comorbidities. New treatment strategies substantially improved survival to discharge (67% preprotocol, 88% postprotocol; P = .015). Among ECMO patients, survival increased to 82% (20% preprotocol; P = .002).


CONCLUSIONS
Our new protocol significantly improved survival to discharge for newborns with CDH. Institution of such a protocol is valuable in improving outcomes for patients with CDH and merits consideration for widespread adoption.
University of Minnesota, Minneapolis, MN 55455, USA. antonoff@umn.edu
Mara B
MB
Antonoff
Virginia A
VA
Hustead
Shawn S
SS
Groth
David J
DJ
Schmeling
D001034:Apgar Score; D001724:Birth Weight; D002985:Clinical Protocols / Q000592:standards; D015897:Comorbidity; D019091:Critical Pathways / Q000706:statistics & numerical data; D015199:Extracorporeal Membrane Oxygenation / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D015996:Survival Rate; D016896:Treatment Outcome