title: Impact of our new protocol on the outcome of the neonates with congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Congenital diaphragmatic hernia (CDH) remains a defiant challenge for pediatric surgeons. Since 2003, we developed a new protocol aiming for the better outcome. In this study, the usefulness of our new protocol was evaluated.
  
  
  METHODS
  Forty-six neonates with CDH at the age of less than 24 h were divided into two groups based on the difference of era and treatment protocols. In Group 1, 15 patients were treated between 1997 and 2002 and 31 patients were treated between 2003 and 2011 in Group 2. In the latter group, a new protocol was introduced focusing on the prevention of lung edema as well as lung injury by steroid administration and on the stabilization of cardiopulmonary function using continuous D-mannitol infusion. The survival rate and the postoperative intubation period (POIP) were compared between the two groups.
  
  
  RESULTS
  The overall survival rate was significantly increased from 53 % (8/15) to 81 % (25/31) (p < 0.05). In isolated CDH, the survival rate was increased from 58 to 93 %. The average POIP was remarkably shortened from 39.0 to 4.4 days (p < 0.01).
  
  
  CONCLUSIONS
  Our new protocol remarkably improved the survival rate and shortened the period of mechanical ventilation in neonates with CDH.
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. osamu@koto.kpu-m.ac.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Kimura
authors.forename: Taizo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Koji
authors.initials: K
authors.lastname: Higuchi
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Shigehisa
authors.initials: S
authors.lastname: Fumino
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Aoi
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D002985:Clinical Protocols; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D011182:Postoperative Care; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D011663:Pulmonary Surfactants