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Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization

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Abstract

Background/Objectives

No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient’s circulatory stabilization (CS) was achieved.

Patients and methods

This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T, <0.10) was further investigated in both groups.

Results

The overall survival rate (SR) was 93.8% in the GV + CS group and 59.1% in the FS group, respectively (P = 0.04). For the patients with the lower L/T, the SR was 85.7% in GV + CS group and 53.8% in the FS group (P = 0.33). Regarding the patients using a patch and liver-up, the SR in GV + CS group was better than that in the FS group (patch: FS 44.4%, GV ± CS 87.5%, P = 0.18; liver-up: FS 57.8 and 87.5%, P = 0.30).

Conclusion

Our strategy of using GV ± CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients.

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Acknowledgments

We would like to thank Mr. Brian Quinn for reviewing the English used in this manuscript. This study was partly supported by a Grant-in-Aid for Scientific Research of the Ministry of Education and Science in Japan (Grant no. 19592061).

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Authors and Affiliations

  1. Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kouji Masumoto, Risa Teshiba, Genshiro Esumi, Kouji Nagata & Tomoaki Taguchi

  2. Department of Pediatrics, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan

    Yasushi Takahata, Shunji Hikino & Toshiro Hara

  3. Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan

    Satoshi Hojo, Kiyomi Tsukimori & Norio Wake

  4. Department of Medical Information Science, Kyushu University Hospital, Fukuoka, Japan

    Naoko Kinukawa

Authors
  1. Kouji Masumoto
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  2. Risa Teshiba
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  3. Genshiro Esumi
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  7. Toshiro Hara
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  9. Kiyomi Tsukimori
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  10. Norio Wake
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  11. Naoko Kinukawa
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  12. Tomoaki Taguchi
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Correspondence to Kouji Masumoto.

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Masumoto, K., Teshiba, R., Esumi, G. et al. Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization. Pediatr Surg Int 25, 487–492 (2009). https://doi.org/10.1007/s00383-009-2370-6

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  • DOI: https://doi.org/10.1007/s00383-009-2370-6

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