title: Repair of congenital diaphragmatic hernia during extracorporeal life support: experience with six neonates.
abstract: BACKGROUND
  The management of congenital diaphragmatic hernia (CDH) in neonates has evolved considerably over the last three decades. Initial stabilization followed by surgical repair is the current standard of care. A subset fails to achieve adequate oxygenation with medical management, including the use of high frequency oscillation and inhaled nitric oxide. The mortality in this group exceeds 80% without additional management strategies. Extracorporeal life support (ECLS) is a well-established modality for managing these neonates with CDH and has been shown to improve early survival in selected cases.
  
  
  METHODS
  This is a retrospective analysis of six neonates with CDH who underwent repair during ECLS between September 2011 and November 2014.
  
  
  RESULTS
  Of 24 admissions with CDH, there were six neonates (25%) who required ECLS. All the six had CDH repair during ECLS. There were no intra-operative bleeding complications. There were no clotting complications related to stopping heparin during CDH repair. There was one hospital death. Five neonates were weaned from ECLS and discharged home.
  
  
  CONCLUSIONS
  Data from our small cohort of patients illustrate that early survival is possible in extremely compromised neonates who otherwise would have died without ECLS. Our experience demonstrates that CDH repair can safely be performed during ECLS. Use of ECLS, early repair during ECLS, lung protective ventilation strategies and aggressive management of pulmonary hypertension were associated with good early survival. ECLS should be considered as an integral part of therapeutic armamentarium for CDH in neonates.
authors.affiliation: Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.|University of Queensland, Brisbane, Queensland, Australia.|Mater Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Prabhu
authors.affiliation: Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.|Mater Medical Research Institute, Brisbane, Queensland, Australia.|Paediatric Intensive Care, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Mattke
authors.affiliation: Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.|University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Department of Surgery, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: McBride
authors.affiliation: Neonatal Intensive Care Unit, Mater Health Services, Brisbane, Queensland, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Cooke
authors.affiliation: Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.|University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Karl
authors.affiliation: Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.|University of Queensland, Brisbane, Queensland, Australia.|Mater Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Nelson
authors.initials: N
authors.lastname: Alphonso
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011793:Queensland / Q000453:epidemiology; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: congenital diaphragmatic hernia; extracorporeal life support