Management of pulmonary hypertension in congenital diaphragmatic hernia: nitric oxide with prostaglandin-E1 versus nitric oxide alone
- 338 Downloads
Prostaglandin-E1 (PGE1) is used at most centers for treating pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH) because it has been regarded as effective. The aim of this study was to investigate the role of PGE1 for treating PH in CDH.
We reviewed 49 CDH cases with echocardiography-proven PH. PH was treated with PGE1 and nitric oxide (NO) and high frequency oscillatory ventilation (HFOV) from 1997 to 2001 (PG + NO; n = 19) and with NO and HFOV from 2002 to 2007 (NO; n = 30).
Subject demographics, severity of PH, and presence of other anomalies were not significantly different between the two groups. In the PG + NO group, 12/19 (63.2%) survived (PG + NO-s) and 7/19 (36.8%) died (PG + NO-d). In the NO group, 21/30 (70.0%) survived (NO-s) and 9/30 (30.0%) died (NO-d). Survival rates were not significantly different. In the NO-s group, spontaneous closure of the ductus arteriosus (DA) was significantly earlier compared with the PG + NO-s group (P < 0.01; 4.0 ± 0.9 vs. 9.5 ± 2.2 days after birth). DA diameters were significantly larger in groups that died compared with groups that survived (P < 0.01), and PH persisted in groups that died. In the NO-s group, surgery was possible significantly earlier compared with the PG + NO-s group (P < 0.01; 3.75 ± 0.67 vs. 6.12 ± 0.78 days after birth). No NO-s case developed a PH crisis even though PGE1 was not used. Hospital stay was significantly shorter in the NO-s group compared with the PG + NO-s group (P < 0.05; 39.9 ± 19 vs. 53.2 ± 23 days).
Nitric oxide alone would appear to simplify the management of CDH with PH and provide better outcome.
KeywordsCongenital diaphragmatic hernia Pulmonary hypertension Prostaglandin-E1 Nitric oxide
- 3.Bedoyan JK, Blackwell SC, Treadwell MC, Johnson A, Klein MD (2005) Congenital diaphragmatic hernia: associated anomalies and antenatally diagnosis. Pediatr Surg Int 20:170–176Google Scholar
- 5.Inamura N, Kubota A, Nakajima T, Kayatani F, Okuyama H, Oue T, Kawahara H (2005) A proposal of new therapeutic strategy for antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 37:357–366Google Scholar
- 8.O’Tool SJ, Karamanoukian HL, Glick PL (1996) Cardiopulmonary consequences of congenital diaphragmatic hernia. J Pedinatol 16:34–39Google Scholar
- 12.Geggel RL, Muraphy JD, Langleben D, Crone RK, Vacanti JP, Reid LM (1985) Congenital diaphragmatic hernia: arterial structural changes and persistent pulmonary hypertension after surgical repair. J Pediatr 107:357–364Google Scholar
- 18.The Congenital Diaphragmatic Hernia Study Group (2006) Treatment evolution in high-risk congenital diaphragmatic hernia. Ann Surg 244:505–513Google Scholar