Abstract
Purpose : Congenital diaphragmatic hernia (CDH), especially prenatally diagnosed, remains an unsolved problem in neonatal surgery. To evaluate the effect of gentle ventilation for neonates with CDH, we established a new protocolized approach to the management in our institution. Materials and Methods : Twenty-one patients with prenatally diagnosed CDH were treated at Children's Research Hospital, Kyoto Prefectural University of Medicine from 1992 to 2005. These 21 patients were divided into 2 groups : Group 1, 13 patients from 1992 to 2002 who had conservative therapy with hyperventilation, muscle relaxants, and unlimited mean airway pressure. Group 2, 8 patients from 2003 to 2005 who had a new protocolized management with gentle ventilation, steroid, diuretic, and surfactant. Results : These two groups were compared with respect to risk factors such as age at diagnosis, gestational age, birth weight, method of delivery, overall anomalies, severe cardiac disease, side of hernia, stomach and liver in chest, area of defect, and patch repair. There were statistically no differences between these 2 groups. Seven of the 8 patients (88%) receiving gentle ventilation survived, and six of the 13 patients (46%) receiving conservative therapy survived. However, there was no significant difference in the survival between the 2 groups. Total ventilator days, ventilator days after operation, and duration of hospitalization in the gentle ventilation therapy were significantly shortened, compared with those in the conservative therapy. Conclusion : In the management of neonates with highrisk CDH, gentle ventilation might be effective because of less iatrogenic ventilator injury.
