J Korean Assoc Pediatr Surg.  2006 Dec;12(2):192-201.

Prognosis of Bochdalek Hernia in Neonate after Change in Management Principle

• Seo JY
• Nam SH
• Kim DY
• Kim SC
• Kim AR
• Kim KS
• Pi SY
• Kim IK

Abstract

There are considerable controversies in the management of congenital diaphragmatic hernia. By 1997, early operation, routine chest tube on the ipsilateral side and maintainingrespiratory alkalosis by hyperventilation were our principles (period I). With a transition period from 1998 to 1999, delayed operation with sufficient resuscitation, without routine chest tube, and permissive hypercapnia were adopted as our practice. High frequency oscillatory ventilation (HFOV) and nitric oxide (NO) were applied, if necessary, since year 2000(period II). Sixty-seven cases of neonatal Bochdalek hernia from 1989 to 2005 were reviewed retrospectively. There were 33 and 34 cases in period I and II, respectively. The neonatal survival rates were 60.6 % and 73.5 %, respectively, but the difference was not significant. In period I, prematurity, low birth weight, prenatal diagnosis, inborn, and associated anomalies were considered as the significant poor prognostic factors, all of which were converted to nonsignificant in period II. In summary, improved survival was not observed in later period. The factors considered to be significant for poor prognosis were converted to be nonsignificant after change of the management principle. Therefore, we recommend delayed operation after sufficient period of stabilization and the avoidance of the routine insertion of chest tube. The validity of NO and HFOV needs further investigation.

Keyword

Neonate; Bochdalek hernia; Congenital diaphragmatic hernia

MeSH Terms

Alkalosis
Chest Tubes
Hernia*
Hernia, Diaphragmatic
Humans
Hypercapnia
Hyperventilation
Infant, Low Birth Weight
Infant, Newborn*
Nitric Oxide
Prenatal Diagnosis
Prognosis*
Resuscitation
Retrospective Studies
Survival Rate
Ventilation
Nitric Oxide