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May 1987

Neonatal Diaphragmatic Hernia: An Improving Outlook With Extracorporeal Membrane Oxygenation

Author Affiliations

From the Departments of Pediatric Surgery (Drs Weber, Connors, Pennington, Westfall, and Lewis) and Pediatrics (Drs Keenan and Kotagal), St Louis University School of Medicine, and Cardinal Glennon Children's Hospital (Drs Weber, Connors, Pennington, Westfall, Keenan, Kotagal, and Lewis), St Louis.

Arch Surg. 1987;122(5):615-618. doi:10.1001/archsurg.1987.01400170121018

• In a 15-year period, 89 newborns were treated for congenital diaphragmatic hernia. The patients were divided into three groups, depending on postoperative therapeutic support available: group 1, ventilator therapy only; group 2, ventilator therapy plus pulmonary vasodilators (tolazoline hydrochloride); and group 3, ventilators, tolazoline, and/or extracorporeal membrane oxygenation (ECMO). The three groups were identical for presenting symptoms, signs, and preoperative blood gas determinations. The survival for each group was as follows: group 1, 17 (40%) of 42; group 2, 14 (45%) of 31; and group 3,12(75%) of 16. Complications requiring further operations were identical. All survivors in groups 1 and 2 are normal developmentally, while one of five group 3 ECMO survivors has developmental delay and another has long-term ventilator dependence. These data suggest that ECMO, an invasive technique for newborn respiratory failure, improves survival in congenital diaphragmatic hernia.

(Arch Surg 1987;122:615-618)

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