AAP paperDoes the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high-risk patients with congenital diaphragmatic hernia?
Section snippets
Methods
We prospectively studied all high-risk patients with CDH from January 2005 to December 2010 under an approved institutional review board protocol (M02-10-240). Prenatally diagnosed infants with CDH were referred to the Advanced Fetal Care Center. We defined high-risk lesions based on fetal magnetic resonance imaging measurements, a method previously reported by our group [11]. Percentage of predicted lung volume (PLV) was calculated by the same 2 radiologists, and all lesions with less than 15%
Results
A total of 17 high-risk infants were identified. Seven received EXIT to ECMO, and 10 received standard delivery (3 vaginal deliveries and 7 cesarean deliveries). One hundred percent of the non-EXIT group required ECMO. The demographics of our cohort are summarized in Table 1. The gestational age at birth and birth weight were similar between groups, with the average being 37.4 weeks gestation and 2.83 kg, respectively. The average gestational age at prenatal imaging was similar. There were more
Discussion
The management of CDH continues to be controversial and challenging. Many studies have examined ways to predict high-risk patients and mortality [13], [14], but there have been very few convincing demonstrations that the high mortality associated with the highest risk patients can be ameliorated. Our inclusion criteria of looking at percentage of PLV less than 15% accurately predicated high risk. At our institution, ECMO is only used 36% of the time, and our survival with our total ECMO
Acknowledgments
Thank you to the outstanding team at Children's Hospital Boston, including the obstetricians, neonatologists, pediatric intensivists, respiratory therapists, and nurses for continuing to provide outstanding care for these and all other very challenging patients. Thank you to the CDH Study Group for providing us with the records of the patients.
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