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01-06-2009 | Original Article

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

Authors: Kouji Masumoto, Risa Teshiba, Genshiro Esumi, Kouji Nagata, Yasushi Takahata, Shunji Hikino, Toshiro Hara, Satoshi Hojo, Kiyomi Tsukimori, Norio Wake, Naoko Kinukawa, Tomoaki Taguchi

Published in: Pediatric Surgery International | Issue 6/2009

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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Title: Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization
Authors: Kouji Masumoto
Risa Teshiba
Genshiro Esumi
Kouji Nagata
Yasushi Takahata
Shunji Hikino
Toshiro Hara
Satoshi Hojo
Kiyomi Tsukimori
Norio Wake
Naoko Kinukawa
Tomoaki Taguchi
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 6/2009
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-009-2370-6

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background/Objectives

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background/Objectives

Patients and methods

Results

Conclusion

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