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- Title
The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia.
- Authors
Morikawa, Nobuyuki; Kuroda, Tatsuo; Honna, Toshiro; Kitano, Yoshihiro; Takayasu, Hajime; Ito, Yushi; Nakamura, Tomoo; Nakagawa, Satoshi; Hayashi, Satoshi; Sago, Haruhiko
- Abstract
<bold>Background/purpose: </bold>Although the prognosis of congenital diaphragmatic hernia (CDH) is determined by the degree of pulmonary hypoplasia, there may be an occult contribution of infection to outcomes. The purpose of this study is to evaluate the effects of our new supportive therapy to prevent infectious complications on mortality and morbidity of CDH.<bold>Methods: </bold>Among 57 cases with CDH treated between 2002 and 2007, 43 prenatally diagnosed isolated cases were enrolled in this study. All patients were managed by a lung-protective strategy and delayed surgery. Since January 2006, we have optimized our perioperative care to reduce infectious complications by using peripherally inserted central catheters and restriction of invasive procedures including extracorporeal membranous oxygenation (ECMO). The survival rate, intubation period, maximum serum C-reactive protein (CRP) level, and complications were compared before and after the introduction of refined supportive therapy.<bold>Results: </bold>There were 25 cases (12 liver-up, 13 liver-down) treated before 2006 and 18 cases (8 liver-up, 10 liver-down) after 2006. ECMO was required for stabilization in five cases before 2006. The survival rates of total, liver-up, and liver-down cases improved from 60, 42, 77, to 83, 63, 100% after 2006, respectively. The intubation period was shortened from 37.8 +/- 24.3 to 22.2 +/- 10.8 days, and the maximum serum CRP level declined from 12.8 +/- 11.5 to 2.2 +/- 1.6 mg/dl after 2006. Nine cases developed sepsis before 2006 whereas no patients suffered from sepsis or pneumonia after 2006.<bold>Conclusion: </bold>The new supportive therapy with strict infection control improved survival rate of prenatally diagnosed CDH without using ECMO.
- Subjects
HERNIA; ABDOMEN; ABDOMINAL diseases; THERAPEUTICS; SERUM; ANTIBIOTICS; HERNIA surgery; PNEUMONIA prevention; SEPTICEMIA prevention; THERAPEUTIC use of narcotics; ANALGESICS; MORPHINE; DRUG therapy; CATHETER-related infections; C-reactive protein; CATHETERS; CHOLESTASIS; PREVENTION of communicable diseases; DIAPHRAGMATIC hernia; DRUG utilization; ENTERAL feeding; EXTRACORPOREAL membrane oxygenation; GENETIC disorders; HIGH-frequency ventilation (Therapy); NEONATAL intensive care; PRENATAL diagnosis; VENOUS thrombosis; NEONATAL intensive care units; RETROSPECTIVE studies; CENTRAL venous catheterization; DIAGNOSIS; INFECTION prevention
- Publication
Pediatric Surgery International, 2008, Vol 24, Issue 10, p1105
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-008-2226-5