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Left-sided congenital diaphragmatic hernia: can we improve survival while decreasing ECMO?

Journal of Perinatology volume 40, pages 935–942 (2020)Cite this article

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Abstract

Background

Mortality and ECMO rates for congenital diaphragmatic hernia (CDH) remain ~30%. In 2016, we changed our CDH guidelines to minimize stimulation while relying on preductal oxygen saturation, lower mean airway pressures, stricter criteria for nitric oxide (iNO), and inotrope use. We compared rates of ECMO, survival, and survival without ECMO between the two epochs.

Design/Methods

Retrospective review of left-sided CDH neonates at the University of Utah/Primary Children’s Hospital NICUs during pre (2003–2015, n = 163) and post (2016–2019, n = 53) epochs was conducted. Regression analysis controlled for defect size and intra-thoracic liver.

Results

Following guideline changes, we identified a decrease in ECMO (37 to 13%; p = 0.001) and an increase in survival without ECMO (53 to 79%, p = 0.0001). Overall survival increased from 74 to 89% (p = 0.035).

Conclusion(s)

CDH management guideline changes focusing on minimizing stimulation, using preductal saturation and less aggressive ventilator/inotrope support were associated with decreased ECMO use and improved survival.

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Authors and Affiliations

  1. Division of Neonatology, University of Utah School of Medicine and Primary Children’s Hospital, Intermountain Health, Salt Lake City, UT, USA

    Michelle J. Yang, Christian Con Yost & Bradley A. Yoder

  2. Division of Pediatric Surgery, University of Utah School of Medicine and Primary Children’s Hospital, Intermountain Health, Salt Lake City, UT, USA

    Stephen Fenton & Katie Russell

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  1. Michelle J. Yang
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  4. Christian Con Yost
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Contributions

No outside honorarium, grant, or other form of payment was provided to anyone to produce the manuscript. MJY and BAY contributed to the conception and design of the study, data collection and analysis, and manuscript preparation; SF, KR, and CCY contributed to conception and design as well as manuscript preparation. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Michelle J. Yang.

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Yang, M.J., Fenton, S., Russell, K. et al. Left-sided congenital diaphragmatic hernia: can we improve survival while decreasing ECMO?. J Perinatol 40, 935–942 (2020). https://doi.org/10.1038/s41372-020-0615-3

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