Introduction

Despite advances in neonatal intensive care including conventional ventilation, surfactant, high frequency oscillation (HFO), nitric oxide (NO) and ECMO, survival for neonates with CDH remains low. A recent review from two large series showed a survival of 61% and 69% for neonates with CDH. (J Pediatr Surg 1997;32:401-405)

Methods

Since 1993, we adopted a protocolized approach for the management of neonates with CDH consisting of weekly prenatal steroids starting at 34 weeks, intubation and paralysis in the caseroom, early administration of surfactant, gentle ventilation, permissive hypercapnea, delayed surgery, trial of HFO, NO, and ECMO if necessary.

In this retrospective study we reviewed charts of all 49 neonates admitted to our Neonatal Intensive Care Unit with a diagnosis of isolated CDH from 1993 to 1997. The RAH is the ECMO referral centre for Western Canada. None of the published pre and postnatal factors predicting poor outcome were considered exclusion criteria for maximal support.

Results

No significant differences in mortality were observed between inborn and outborn neonates. Oxygenation indices and lactate levels (mmol/L) prior to cannulation were significantly lower, 58±9 and 9±4 in inborns when compared with 80±34 and 13±6 for outborn neonates,(p=0.027; mean±SD). Results from 49 neonates with CDH are reported below.

Conclusions

Our data supports that a protocolized approach improves survival in neonates with CDH. We recommend delivery of neonates with CDH in a Level III Centre with ECMO availability. Table

Table 1 No caption available.
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