1338 148 Cases of Congenital Diaphragmati Hernia: Our Experience

Background: The prognosis of babies with CDHremains unsatisfactory despite recent advances inmedical and surgical treatment. Recent studies have proved that mortality rate inhigh risk patients is around 50-60%. Methods: 148 neonates affected with CDH weretreated in the NICU of Bergamo, from 1994 to2009. In the case of pulmonary hypertension iNO isgiven, if neonates show severe hypoxia refractoryto conventional therapies, they are treated withECMO. Only when a stable situation is reached, can surgicalrepair be performed, in the NICU, during HFOV. In the case of wide defects or complete agenesisof the diaphragm (53 cases), prosthetic material isused (Gore-Tex). After the surgical operation HFO ventilation iscarried out, followed by weaning of the conventionalventilation until extubation. Results: Antenatal echographyc diagnosis wasmade in 91 cases. Gestational age was 38 ± 2.2weeks. There were116 left CDH and 18 right CDH; 14 hemidiaphragmagenesis. Major associated anomalies have been identified in33 patients and 9 newborns had a gestational ageof < 35 w. In 18 cases stabilization was not obtained andneonates died before undergoing surgery. 5neonates underwent ECMO. 49 babies were treatedwith iNO. 102 neonates survived (68.9 %) and survivalreaches 75.8 % if we exclude neonates with majorassociated anomalies and 80.5% if we also excludepreterm infants. Conclusions: The use of advanced techniques ofventilation assistance, associated with pre-surgicalclinical stabilization and surgery performed in theNICU, during HFOV, have improved the outcomeand the CDH neonatal survival.