[Congenital diaphragmatic hernia. Antenatal diagnosis. thoracic drainage. High frequency ventilation].

25 children with a congenital diaphragmatic hernia diagnosed in the first 24 hours of life were referred to the Clinique de Chirurgie Pédiatrique de Nancy. The total survival rate was 68%. Patients were divided into two chronologic groups. From 1979 to 1981. Of this group of 11 patients, five died: two, one week after the operation and three immediately after. From 1982 to 1984. Of those 14 patients treated, three died: two before the intervention and one three months after. Three factors explain these results: Antenatal diagnosis. It was made in 8 patients. Only one died before the operation (a 620 g polymalformated premature baby). All were in the second group. High frequency ventilation. It was made in 4 patients. All survived although one of them had a severe pulmonary hypoplasia. They were all in the second group. In 16 patients, no pleural cavity was used. These three factors act in the same way: no persistent fetal circulation. The antenatal diagnosis helps to a better neonatal care and the chances of returning to the fetal circulation are reduced. The high frequency ventilation and the absence of chest cavity drainage lessen the over inflation and barotraumatism with anoxia, acidosis, pulmonary hypertension and reversion to fetal circulation.