Abstract
Introduction: CDH management involves gentle ventilation, hypercarbia, iNO & delayed surgery. ECMO use is limited & associated with greater neurodevelopmental sequelae.
Aim: Study mortality and neurological morbidity of CDH patients at 12 months of age from a tertiary level non-ECMO unit.
Methods: Retrospective review of all CDH neonates presenting to the Children's Hospital at Westmead over 5 years [01/2005 to 12/2009]. Infants were assessed at 1 year using the Bayley Scales of Infant and Toddler Development, Version III. Visual reward orientation audiometry was performed.
Results: Of 37 babies [M=17] referred, 5 [13%] died perioperatively, 6 lost to follow-up & 2 missed developmental review. 30/32 [93%] of the survivors were seen at 1 year and 24/32 [75%] had a neurodevelopmental assessment. Mean GA 37.9 wks (SD ±1.7) & BW 2983gm (± 722.5). CDH diagnosed: 17 antenatal ultrasound [US] < 22 weeks of gestation, 6 later antenatal US and 14 [44%] postnatally. Median age at surgery was 7 days (range 0 to 55). 8 (21%) had an associated cardiac anomaly [4 had surgery]. Below average outcomes in 2 (8%) infants on cognitive skills & expressive language; 6 (23%) receptive language, 7 (27%) in gross motor skills & 2 (8%) deficient in fine motor skills. No sensorineural hearing deficits. Neither mortality nor abnormal neurodevelopmental outcome were significantly associated with prematurity, gender, time of diagnosis, pneumothorax, type of closure and oxygen at discharge.
Conclusion: Mortality rates in a tertiary level non-ECMO unit are comparable with ECMO centres and 1 year neuro-morbidity is lower. The outcome from conventional strategies is comparable in the treatment of most CDH patients where ECMO is not available.
- © 2011 ERS