title: Outcome of congenital diaphragmatic hernia: analysis of implicated factors.
abstract: OBJECTIVE
  Congenital diaphragmatic hernia remains a significant challenge for neonatologists and pediatric surgeons. Over the last years, new therapeutic approaches, as high-frequency oscillatory ventilation, inhaled nitric oxide, permissive hypercapnia, extracorporeal membrane oxygenation, have been used for the management of these newborns. We conducted a retrospective study of all infants who were managed for congenital diaphragmatic hernia in our NICU in order to identify possible clinical characteristics which were predictive for survival.
  
  
  METHODS
  We reviewed a single institution's experience with 42 consecutive neonates with congenital diaphragmatic hernia admitted to our NICU from 1993 to 2009.
  
  
  RESULTS
  Prenatal data and side of congenital diaphragmatic hernia were similar in survivors and no-survivors infants except for the lung-to-head ratio (LHR), which was higher and measured later in survivors than non-survivors. Multiple regression analysis showed that a gestational age ≥39 weeks, Apgar score at 5 min ≥7, FiO2<0.35, MAP<13 cmH2O, OI<10 and AaDO2 >282 before surgical repair, and the absence of persistent pulmonary hypoplasia were independent predictive factors of survival.
  
  
  CONCLUSIONS
  Our study suggests that the outcome of newborns with congenital diaphragmatic hernia still depends on the severity of lung hypoplasia, despite the different respiratory and therapeutical approaches.
authors.affiliation: Division of Neonatology, V. Buzzi Children Hospital of Milan, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Lupo
authors.forename: F
authors.initials: F
authors.lastname: Castoldi
authors.forename: L
authors.initials: L
authors.lastname: Maestri
authors.forename: M
authors.initials: M
authors.lastname: Rustico
authors.forename: C
authors.initials: C
authors.lastname: Dani
authors.forename: G
authors.initials: G
authors.lastname: Lista
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000379:methods; D006612:High-Frequency Ventilation / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009569:Nitric Oxide