Impact of our new protocol on the outcome of the neonates with congenital diaphragmatic hernia

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• 作者：Osamu Kimura (1)
  Taizo Furukawa (1)
  Koji Higuchi (1)
  Yuuki Takeuchi (1)
  Shigehisa Fumino (1)
  Shigeyoshi Aoi (1)
  Tatsuro Tajiri (1)
  
• 关键词：CDH ; Gentle ventilation ; Steroid ; d ; Mannitol ; Surfactant
• 刊名：Pediatric Surgery International
• 出版年：2013
• 出版时间：April 2013
• 年：2013
• 卷：29
• 期：4
• 页码：335-339
• 全文大小：167KB
• 参考文献：1. Boloker J, Bateman DA, Wung JT et al (2002) Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg 37:357-66 CrossRef
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• 作者单位：Osamu Kimura (1)
  Taizo Furukawa (1)
  Koji Higuchi (1)
  Yuuki Takeuchi (1)
  Shigehisa Fumino (1)
  Shigeyoshi Aoi (1)
  Tatsuro Tajiri (1)
  
  1. Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  
• ISSN：1437-9813

文摘

Background/purpose Congenital diaphragmatic hernia (CDH) remains a defiant challenge for pediatric surgeons. Since 2003, we developed a new protocol aiming for the better outcome. In this study, the usefulness of our new protocol was evaluated. Materials and methods Forty-six neonates with CDH at the age of less than 24?h were divided into two groups based on the difference of era and treatment protocols. In Group 1, 15 patients were treated between 1997 and 2002 and 31 patients were treated between 2003 and 2011 in Group 2. In the latter group, a new protocol was introduced focusing on the prevention of lung edema as well as lung injury by steroid administration and on the stabilization of cardiopulmonary function using continuous d-mannitol infusion. The survival rate and the postoperative intubation period (POIP) were compared between the two groups. Results The overall survival rate was significantly increased from 53?% (8/15) to 81?% (25/31) (p?<?0.05). In isolated CDH, the survival rate was increased from 58 to 93?%. The average POIP was remarkably shortened from 39.0 to 4.4?days (p?<?0.01). Conclusion Our new protocol remarkably improved the survival rate and shortened the period of mechanical ventilation in neonates with CDH.