Abstract
Purpose: We reviewed and analyzed the clinical outcomes of all patients with congenital diaphragmatic hernia (CDH) in Okinawa Prefecture and reevaluated the prenatally diagnosed patients’ severity classification group.
Methods: Between 2002 and 2021, 61 patients diagnosed with CDH were treated at our institution. Among them, 35 patients who were prenatally diagnosed with isolated left CDH were classified according to Kitano’s and Usui’s classification systems. Information regarding their perinatal status, cardiorespiratory management, and prognosis was retrospectively reviewed. In addition, the results were compared with those from a national survey.
Results: Extracorporeal membrane oxygenation (ECMO) was administered in 18.0% of patients, 3.3% were unsuitable for surgery, and the overall survival rate was 83.6%. According to Kitano’s classification, 27 patients (77.1%) were classified into Group I; 6 (17.1%), into Group II; and 2 (5.7%), into Group III. Of these 35 prenatally diagnosed patients, 25.7% underwent ECMO, 0% were unable to undergo surgery, and the overall survival was 91.4%. Compared with the nationwide survey results, the prognosis was significantly better in all the patients classified using Kitano’s classification system. In our cohort, ECMO utility and operation rates were significantly higher than those of the national survey. However, the intact discharge rate was lower in our patients, reflecting high complication rates.
Conclusions: The survival rates in our sample were excellent; this may be because almost all the patients were able to undergo surgery owing to the high frequency of ECMO support. We should aim to reduce postoperative complications and improve long-term quality of life.
