Document Detail


Protocolized management of infants with congenital diaphragmatic hernia: effect on survival.
MedLine Citation:
PMID:  21238637     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: In 2006, we introduced a new protocol for congenital diaphragmatic hernia (CDH) management featuring nitric oxide in the delivery room, gentle ventilation, lower criteria for extracorporeal membrane oxygenation (ECMO), and appropriately timed operative repair on ECMO. Our goals were to assess outcomes after institution of this protocol and to compare results with historical controls.
METHODS: Charts were reviewed of all newborns admitted to a large metropolitan children's hospital from 2002 to 2009 with a diagnosis of CDH. Data were recorded regarding delivery, ECMO, operative repair, length of stay, comorbidities/anomalies, complications, and survival. Postprotocol outcomes were compared to those from the preprotocol era and to data from the international CDH Registry.
RESULTS: Comparison of the protocolized group (n = 43) to the historical group (n = 51) revealed no significant differences in gestational age, birth weight, Apgar scores, or comorbidities. New treatment strategies substantially improved survival to discharge (67% preprotocol, 88% postprotocol; P = .015). Among ECMO patients, survival increased to 82% (20% preprotocol; P = .002).
CONCLUSIONS: Our new protocol significantly improved survival to discharge for newborns with CDH. Institution of such a protocol is valuable in improving outcomes for patients with CDH and merits consideration for widespread adoption.
Authors:
Mara B Antonoff; Virginia A Hustead; Shawn S Groth; David J Schmeling
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  46     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-17     Completed Date:  2011-06-27     Revised Date:  2011-12-06    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-46     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
University of Minnesota, Minneapolis, MN 55455, USA. antonoff@umn.edu
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MeSH Terms
Descriptor/Qualifier:
Apgar Score
Birth Weight
Clinical Protocols / standards
Comorbidity
Critical Pathways / statistics & numerical data
Extracorporeal Membrane Oxygenation / standards,  utilization
Female
Gestational Age
Heart Defects, Congenital / epidemiology
Hernia, Diaphragmatic* / congenital,  mortality,  surgery,  therapy
Humans
Hypertension, Pulmonary / epidemiology
Infant, Newborn
Longitudinal Studies
Male
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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