Seminars in pediatric surgery
-
Semin. Pediatr. Surg. · Nov 1996
ReviewExtracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia.
Since the introduction of extracorporeal membrane oxygenation (ECMO) support for neonatal respiratory failure, the use of ECMO for infants with congenital diaphragmatic hernia has increased significantly. ECMO is offered to infants with a high risk of dying (with reported survival rates of 38% to 65%). Unstable infants can be placed on ECMO with subsequent repair on ECMO or after weaning from support. ⋯ Most centers use venoarterial ECMO in patients with congenital diaphragmatic hernia (CDH), but venovenous ECMO appears as effective. ECMO support appears to have improved the survival rate in high-risk infants with CDH, but because almost all studies are retrospective single institutional and have small numbers of patients, the true improvement in survival rate is difficult to quantitate. Further studies of the value of ECMO in patients with CDH are warranted.
-
Semin. Pediatr. Surg. · Nov 1996
ReviewInnovative therapies in the management of newborns with congenital diaphragmatic hernia.
A number of innovative approaches have been explored in the hope of improving the outcome in newborns with congenital diaphragmatic hernia (CDH) and respiratory insufficiency. Among these are the techniques of delayed approach to the repair of the diaphragmatic hernia; permissive hypercapnia; nitric oxide and surfactant administration; intratracheal pulmonary ventilation; liquid ventilation; perfluorocarbon-induced lung growth; and lung transplantation. Although early in their clinical evolution, these interventions are developing rapidly and hold promise for improving the outcome in patients with CDH.