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

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

J Perinatol. 2020 Feb 17. doi: 10.1038/s41372-020-0615-3. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32066841

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

Yang MJ1Fenton S2Russell K2Yost CC3Yoder BA3.

Author information

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.PMID: 32066841 DOI: 10.1038/s41372-020-0615-3

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