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MINERVA PEDIATRICA

A Journal on Pediatrics, Neonatology, Adolescent Medicine,
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Minerva Pediatrica 2013 June;65(3):279-85

language: English

Outcome of congenital diaphragmatic hernia: analysis of implicated factors

Lupo E. 1, Castoldi F. 1, Maestri L. 2, Rustico M. 3, Dani C. 4, Lista G. 1

1 Division of Neonatology, “V. Buzzi” Children Hospital of Milan, Milan, Italy;
2 Division of Pediatric Surgery, “V. Buzzi” Children Hospital of Milan, Milan, Italy;
3 Department of Obstetrics and Gynecology, “V. Buzzi” Children Hospital of Milan, Milan, Italy;
4 Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy


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Aim: Congenital diaphragmatic hernia remains a significant challenge for neonatologists and pediatric surgeons. Over the last years, new therapeutic approaches, as high-frequency oscillatory ventilation, inhaled nitric oxide, permissive hypercapnia, extracorporeal membrane oxygenation, have been used for the management of these newborns. We conducted a retrospective study of all infants who were managed for congenital diaphragmatic hernia in our NICU in order to identify possible clinical characteristics which were predictive for survival.
Methods: We reviewed a single institution’s experience with 42 consecutive neonates with congenital diaphragmatic hernia admitted to our NICU from 1993 to 2009.
Results: Prenatal data and side of congenital diaphragmatic hernia were similar in survivors and no-survivors infants except for the lung-to-head ratio (LHR), which was higher and measured later in survivors than non-survivors. Multiple regression analysis showed that a gestational age ≥39 weeks, Apgar score at 5 min ≥7, FiO2<0.35, MAP<13 cmH2O, OI<10 and AaDO2 >282 before surgical repair, and the absence of persistent pulmonary hypoplasia were independent predictive factors of survival.
Conclusion: Our study suggests that the outcome of newborns with congenital diaphragmatic hernia still depends on the severity of lung hypoplasia, despite the different respiratory and therapeutical approaches.

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g.lista@icp.mi.it