Table 3.
Interventions and type of surgical repair in neonates with congenital diaphragmatic hernia
| Characteristic | Epoch I | Epoch II | P-value |
|---|---|---|---|
| (N = 26) | (N = 57) | ||
| Primary mechanical ventilation, n (%) | <0.001 | ||
| Intermittent mandatory ventilation | 26 (100) | 0 (0) | |
| Assist-control + volume limit mode | 0 (0) | 26 (45) | |
| Pressure support + volume guarantee mode | 0 (0) | 31 (55) | |
| High frequency oscillatory ventilationa | 0 (0) | 8 (15) | ---- |
| Inhaled nitric oxide | 0 (0) | 31 (54) | <0.001 |
| Surfactant administration | 1 (4) | 16 (28) | <0.001 |
| Vasoactive support | 13 (50) | 55 (96) | <0.001 |
| Died before surgery | 7 (27) | 12 (21) | 0.815 |
| Time between delivery and surgery, hoursb | 24.5 [24.7, 28.2] | 29 [23.0, 29.0] | 0.550 |
| Type of surgical repair | 19 (73) | 45 (79) | 0.815 |
| Primary closure | 18 | 39 | |
| Patch repair | 1 | 5 | |
| Muscle flap repair | 0 | 1 |
All values are N (%) or median [25th, 75th percentile]
aUsed only as a rescue technique
bAlthough current practice shifted from emergent repair of CDH to a policy of preoperative medical stabilization using a variety of intensive care management strategies, a recent Cochrane analysis showed that there was no clear evidence which favors delayed versus immediate (within 24 h of birth) surgical intervention [29]