title: Trends in the treatment and outcome of congenital diaphragmatic hernia over the last decade.
abstract: OBJECTIVE
  Congenital diaphragmatic hernia (CDH) remains a challenging and life-threatening congenital anomaly. The aim was to evaluate whether treatment and survival has changed during the last decade.
  
  
  METHODS
  We retrospectively analysed all consecutive infants with CDH referred to two European tertiary paediatric surgical centres over 11 years (January 1999 to December 2009). Minimum follow-up was 1 year. χ(2) test for trend was used to evaluate significance.
  
  
  RESULTS
  There were 234 infants. There was no significant variation over time in the proportion of infants receiving high frequency oscillatory ventilation (HFOV) (p = 0.89), inhaled nitric oxide (iNO) (p = 0.90) or extracorporeal membrane oxygenation (ECMO) (p = 0.22). 205 infants (88 %) were stabilised and underwent surgical repair; of these, 186 (79 %) survived after surgery. Over time there was a significant increase in the proportion of infants undergoing surgical repair (p = 0.018) without a concomitant significant improvement in survival (p = 0.099).
  
  
  CONCLUSIONS
  This multicentre analysis indicates that the survival rate of infants with CDH referred to two European paediatric surgical centres is high (79 %). The use of HFOV, iNO and ECMO has not changed in recent years. We observed a significant increase in the proportion of infants who undergo surgery but this has not resulted in a significant increase in the overall survival rate.
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK. m.garriboli@ucl.ac.uk
authors.forename: Massimo
authors.initials: M
authors.lastname: Garriboli
authors.forename: Johannes Wolfgang
authors.initials: JW
authors.lastname: Duess
authors.forename: Elke
authors.initials: E
authors.lastname: Ruttenstock
authors.forename: Mark
authors.initials: M
authors.lastname: Bishay
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.forename: Prem
authors.initials: P
authors.lastname: Puri
authors.forename: Michael E
authors.initials: ME
authors.lastname: Höllwarth
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome