Treatment of Congenital Diaphragmatic Hernia in Neonates

Overview

Background.
Treatment of the Congenital Diaphragmatic Hernia in neonates with early manifestations has beenaccompaniedwith significant mortality. Authors present the treatment protocol employed in such children and resultsfrom the period January 1994 to December 2003.Methods and Results. Since January 1994 to December 2003 96 children were cured for the Congenital DiaphragmaticHernia. Ratio F:M was 36:60. 29 children (30 %) were diagnosed prenatally, the remaining newborns werediagnosed on the basis of thoracic X-ray, which was required for the early signs of respiratory insufficiency. Thepostnatal treatment protocol included circulation-ventilation stabilisation, operation, early extubation and initiationof the peroral nourishment. Altogether 78 (81 %) of children were operated after the stabilization using the standardlaparotomy method, 5 children (6%)were operatedwith extra corporalmembrane oxygenation, in 20 children (26%)a Goretexpa tch was used to cover an extensive defect in the diaphragm. Overall survival was 74%, survival ofoperated children was 91%, 75 % of children with a patch survived, survival of children operated with ECMO was40 %. Relapse occurred in one child (1 %) with a patch.Conclusions. Specification of the prenatal diagnosis and collection of patients with CDH into tertiary centres withECMO possibility can improve prognosis of neonates with the malformation.

Key words:
congenital diaphragmatic hernia, ECMO, Goretex, pulmonary hypertension, lung hypoplasia, nitrogenoxide.