Prolonged preoperative stabilization using high-frequency oscillatory ventilation does not improve the outcome in neonates with congenital diaphragmatic hernia

Abstract

Although delayed repair with preoperative stabilization using high-frequency oscillatory ventilation (HFOV) has been advocated in neonates with congenital diaphragmatic hernia (CDH), improved survival has not been reported. We compared survival between neonates undergoing delayed repair after prolonged stabilization for more than 48 h using HFOV and those undergoing immediate repair following short stabilization using HFOV in subjects with high-risk CDH. Patient selection was made by two criteria: fetuses with the lung/thorax transverse area ratio (L/T) below 0.26 and neonates who presented with respiratory distress significant enough to require intubation within 6 h after delivery. Selection of the strategies differed by era and medical center. Stabilization failed in 11 of 18 patients with delayed repair and only 7 patients (38.9%) in this group survived, but 18 of 23 patients (78.3%) in the immediate-repair group survived (P < 0.05). Although lower values of Apgar scores, best postductal PO2 (BPtDPO2), gestational weeks, and L/T and more frequent patch repair were observed in the delayed than in the immediate repair group, significant differences in survival among the subpopulations were also observed in the prenatally diagnosed group, including the group with L/T < 0.15 and the group that required ECMO, the group with the best preductal PO2 (BPrDPO2) ≥ 100 torr, and the group with BPtDPO2 < 100 torr. These results indicate that prolonged stabilization for more than 48 h using HFOV does not improve survival in patients with high-risk CDH.