title: Congenital diaphragmatic hernia: outcomes of neonates treated at Mayo Clinic with and without extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Congenital diaphragmatic hernia (CDH) is a rare anomaly with high mortality and long-term comorbid conditions.
  
  
  OBJECTIVE
  Our aim was to describe the presenting characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution.
  
  
  METHODS
  We performed a retrospective cohort study and identified consecutive neonates treated for CDH from 2001 to 2015 at our institution. For all patients identified, we reviewed hospital and postdischarge data for neonatal, disease, and treatment characteristics. We determined hospital survival overall and also according to the presence of prenatal diagnosis, liver herniation into the chest (liver up), and the use of extracorporeal membrane oxygenation (ECMO) in addition to surgery. We evaluated postdischarge chronic conditions in patients with at least one year of follow-up.
  
  
  RESULTS
  Thirty-eight neonates were admitted for treatment during the study period. In three who were in extremis, life support was withdrawn. The other 35 underwent surgical repair, of whom eight received ECMO. The overall survival was 79% (30/38). Survival for those who had surgical correction of CDH but did not need ECMO was 89% (24/27); it was 75% (6/8) for those who received ECMO and had surgery. Hospital survival was lower for liver-up vs liver-down CDH (61% [11/18] vs 95% [19/20]; odds ratio, 0.08; 95% CI, 0.01-0.77; P = 0.01). Among survivors, the median duration of hospitalization was 31 (interquartile range, 20-73) days. Major chronic pulmonary and gastrointestinal disorders, failure to thrive, and neurodevelopmental delays were the most noted comorbid conditions after discharge, and all were more prevalent in those who required ECMO.
  
  
  CONCLUSIONS
  The overall survival of neonates with CDH was 79%. Intrathoracic liver herniation was associated with more frequent use of ECMO and greater mortality. A substantial number of survivors, especially those who required ECMO, experienced chronic conditions after discharge.
authors.affiliation: Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bojanić
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Woodbury
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Alexandre N
authors.initials: AN
authors.lastname: Cavalcante
authors.affiliation: Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Ruža
authors.initials: R
authors.lastname: Grizelj
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Garth F
authors.initials: GF
authors.lastname: Asay
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Colby
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Carey
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Schears
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Bochdalek hernia; gastroesophageal reflux disease; mortality; pulmonary hypertension; pulmonary hypoplasia; survival