Delayed surgery of a coangenital diaphragmatic hernia without drainage of the ipsilateral hemithorax
Abstract
The objective of the investigation was to evaluate the success of a new therapeutic protocol in patients with congenital diaphragmatic hernia (CDH). During the period from 1/1994 till 12/1998 41 patients with CDH were admitted.
In 36 patients (88 %) left-sided CDH was diagnosed, in 4 patients (10 %) right-sided CDH and one neonate (2 %) bilateral CDH. Fifteen cases (37 %) of CDH were assessed prenatally.
Twenty-two children (54 %) were treated by inhalation of nitric oxide (INO) and 4 patients (10 %) by extracorporeal membrane oxygenation. The total incidence of associated developmental defects was 20 % and the total mortality 34 %.
On comparison of the surviving (group S, n = 27) and the non-surviving NS, n = 14) patients statistically significant diferences were found in the Apgar score during the first minute (S: 5.9 +- 0.5 vs. NS:3.4 +- 0.7, p < 0.008), in the oxygenation index (01) two hours after admission (S:11.9 +- 2.9 vs.
NS:27.7 +- 8.3, p < 0.03), in the alveolo-arterial oxygen difference (AaD02) 2 hours and 12 hours after admission (S:369 +- 47 ton and 237 +- 47 ton resp. vs. NS: 552 +- 29 ton and 557 +- 26 ton resp., p < 0.02) and in the need to start extracorporeal membrane oxygenation (S:3.7 % vs.
NS:21.4 %, p < 0.009). The investigation confirmed a reduced mortality of neonates with CDH by introducing new therapeutic methods.
Risk factors are early prenatal diagnosis, the presence of associated developmental defects, high values of oxygenation and ventilation with the necessity to start nitric oxide inhalation.