Division of Neonatology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.
Division of Pediatric Surgery, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.
J Perinatol. 2020 Jun;40(6):935-942. doi: 10.1038/s41372-020-0615-3. Epub 2020 Feb 17.
Mortality and ECMO rates for congenital diaphragmatic hernia (CDH) remain ~30%. In 2016, we changed our CDH guidelines to minimize stimulation while relying on preductal oxygen saturation, lower mean airway pressures, stricter criteria for nitric oxide (iNO), and inotrope use. We compared rates of ECMO, survival, and survival without ECMO between the two epochs.
DESIGN/METHODS: Retrospective review of left-sided CDH neonates at the University of Utah/Primary Children's Hospital NICUs during pre (2003-2015, n = 163) and post (2016-2019, n = 53) epochs was conducted. Regression analysis controlled for defect size and intra-thoracic liver.
Following guideline changes, we identified a decrease in ECMO (37 to 13%; p = 0.001) and an increase in survival without ECMO (53 to 79%, p = 0.0001). Overall survival increased from 74 to 89% (p = 0.035).
CONCLUSION(S): CDH management guideline changes focusing on minimizing stimulation, using preductal saturation and less aggressive ventilator/inotrope support were associated with decreased ECMO use and improved survival.
先天性膈疝 (CDH) 的死亡率和体外膜肺氧合 (ECMO) 使用率仍约为 30%。2016 年，我们改变了 CDH 指南，以尽量减少刺激，同时依靠导管前血氧饱和度、降低平均气道压力、更严格的一氧化氮（iNO）和儿茶酚胺类药物使用标准。我们比较了两个时期 ECMO、存活率和无 ECMO 存活率的差异。
方法/设计：对犹他大学/儿童初级保健医院新生儿重症监护病房左侧 CDH 新生儿进行回顾性研究，研究时间为 2003-2015 年前（n=163）和 2016-2019 年后（n=53）。回归分析控制了缺陷大小和胸腔内肝的影响。
在指南改变后，我们发现 ECMO 使用率降低（从 37%降至 13%；p=0.001），无 ECMO 存活率增加（从 53%升至 79%，p=0.0001）。总体存活率从 74%增加到 89%（p=0.035）。
以尽量减少刺激、使用导管前血氧饱和度和减少使用呼吸机/儿茶酚胺类药物为重点的 CDH 管理指南改变与 ECMO 使用减少和存活率提高相关。
