Improved survival for infants with severe congenital diaphragmatic hernia

Background Survival for severe (observed to expected lung-head ratio (O:E LHR) < 25%) congenital diaphragmatic hernia (CDH) remains a challenge (15-25%). Management strategies have focused on fetal endoscopic tracheal occlusion (FETO) and/or extracorporeal membrane oxygenation therapy (ECMO) utilization. Objective(s) Describe single center outcomes for infants with severe CDH. Study design Observational study of 13 severe CDH infants managed with ECMO, a protocolized DR algorithm, and early repair on ECMO with an innovative perioperative anticoagulation strategy. Results 13/140 (9.3%) infants met criteria and were managed with ECMO. 77% survived ECMO and 69% survived to discharge. 22% underwent tracheostomy. Median days on mechanical ventilation was 39 days (IQR 22:107.5) and length of stay 135 days (IQR 62.5:211.5). All infants received a gastrostomy tube (GT) and were discharged home on oxygen and pulmonary hypertension (PH) meds. Conclusion Survival for infants with severe CDH can be optimized with early aggressive intervention and protocolized algorithms (149).

Automated summary

This study observed the management outcomes of 13 infants with severe congenital diaphragmatic hernia (CDH), who were treated with ECMO, a protocolized algorithm, and early repair. The results showed a survival rate of 77% on ECMO and a discharge survival rate of 69%. The median duration of mechanical ventilation was 39 days, and the median length of hospital stay was 135 days. All infants received a gastrostomy tube and continued to use oxygen and pulmonary hypertension medication at home.