{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T04:39:26Z","timestamp":1771907966465,"version":"3.50.1"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,9,1]]},"abstract":"<jats:p>Background. Congenital diaphragmatic hernia (CDH) is a malformation of the diaphragm that allows bowel to enter the thoracic cavity, resulting in pulmonary hypoplasia and pulmonary hypertension. Approximately 50% of CDH patients are treated with extracorporeal membrane oxygenation (ECMO). The optimal gestational age for delivery of term infants with CDH at high risk for requiring ECMO is not known. The goal of this study was to compare survival of infants with CDH receiving ECMO born early term (38 0\/7\u201339 6\/7 weeks\u2019 gestation) with those born late term (40 0\/7\u201341 6\/7 weeks\u2019 gestation). Changes in survival rates of term infants and the factors associated with these changes were assessed over the 25 years that ECMO has been available.<\/jats:p><jats:p>Methods. Design. Retrospective cohort study of infants with CDH treated with ECMO.<\/jats:p><jats:p>Data Sources. The Extracorporeal Life Support Organization registry of patients treated at active Extracorporeal Life Support Organization centers from April 1976 through June 2001.<\/jats:p><jats:p>Analysis. Survival and clinical predictors of survival were compared between infants born early term (38 0\/7\u201339 6\/7 weeks\u2019 gestation) and infants born late term (40 0\/7\u201341 6\/7 weeks\u2019 gestation). Changes in survival rates over time and factors associated with survival were evaluated.<\/jats:p><jats:p>Results. Among full-term infants with CDH treated with ECMO, late-term compared with early-term delivery was associated with improved survival (63% vs 53%). Among full-term survivors of ECMO, late-term infants spent less time on ECMO (181 vs 197 hours) and less time in the hospital (60 vs 67 days). In multivariate analysis, greater birth weight, higher 5-minute Apgar score, higher arterial pH and Pco2 &amp;lt;50 torr before ECMO, and absence of a prenatal diagnosis of CDH were associated with survival.<\/jats:p><jats:p>Since the late 1980s, survival of infants with CDH requiring ECMO decreased from 63% to 52%. The decreased survival rate was associated with increased rates of prenatal diagnosis, early-term delivery, lower birth weight, longer ECMO runs, and more frequent complications on ECMO.<\/jats:p><jats:p>Conclusions. Among term infants with CDH receiving ECMO, late-term delivery compared with early-term delivery is associated with improved survival, shorter ECMO duration, shorter hospital length of stay, and fewer complications on ECMO. These data suggest that, at least for the \u223c50% of CDH patients treated with ECMO, outcomes for infants with CDH may be improved by delay of elective delivery until 40 completed weeks of gestation.<\/jats:p>","DOI":"10.1542\/peds.110.3.590","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:17:55Z","timestamp":1092442675000},"page":"590-596","source":"Crossref","is-referenced-by-count":63,"title":["Survival in Early- and Late-Term Infants With Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation"],"prefix":"10.1542","volume":"110","author":[{"given":"Timothy P.","family":"Stevens","sequence":"first","affiliation":[{"name":"Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia R.","family":"Chess","sequence":"additional","affiliation":[{"name":"Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth M.","family":"McConnochie","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Department of Pediatrics, Strong Children\u2019s Research Center, Golisano Children\u2019s Hospital at Strong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Sinkin","sequence":"additional","affiliation":[{"name":"Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronnie","family":"Guillet","sequence":"additional","affiliation":[{"name":"Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William M.","family":"Maniscalco","sequence":"additional","affiliation":[{"name":"Division of Neonatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan G.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2002,9,1]]},"reference":[{"key":"2021121006233310500_R1","doi-asserted-by":"crossref","unstructured":"Metkus AP, Esserman L, Sola A, Harrison MR, Adzick NS. Cost per anomaly: what does a diaphragmatic hernia cost?J Pediatr Surg.1995;30:226\u2013230","DOI":"10.1016\/0022-3468(95)90565-0"},{"key":"2021121006233310500_R2","doi-asserted-by":"crossref","unstructured":"Harrison MR, Adzick NS, Estes JM, Howell LJ. A prospective study of the outcome for fetuses with diaphragmatic hernia. JAMA.1994;271:382\u2013384","DOI":"10.1001\/jama.271.5.382"},{"key":"2021121006233310500_R3","doi-asserted-by":"crossref","unstructured":"Reickert CA, Hirschl RB, Schumacher R, et al. Effect of very delayed repair of congenital diaphragmatic hernia on survival and extracorporeal life support use. Surgery.1996;120:766\u2013772","DOI":"10.1016\/S0039-6060(96)80029-8"},{"key":"2021121006233310500_R4","doi-asserted-by":"crossref","unstructured":"Puri P, Wester T. Historical aspects of congenital diaphragmatic hernia. Pediatr Surg Int.1997;12:95\u2013100","DOI":"10.1007\/BF01349971"},{"key":"2021121006233310500_R5","doi-asserted-by":"crossref","unstructured":"Clark RH, Hardin WD Jr, Hirschl RB, et al. Current surgical management of congenital diaphragmatic hernia: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg.1998;33:1004\u20131009","DOI":"10.1016\/S0022-3468(98)90522-X"},{"key":"2021121006233310500_R6","doi-asserted-by":"crossref","unstructured":"Beresford MW, Shaw NJ. Outcome of congenital diaphragmatic hernia. Pediatr Pulmonol.2000;30:249\u2013256","DOI":"10.1002\/1099-0496(200009)30:3<249::AID-PPUL9>3.0.CO;2-9"},{"key":"2021121006233310500_R7","doi-asserted-by":"crossref","unstructured":"Mallik K, Rodgers BM, McGahren ED. Congenital diaphragmatic hernia: experience in a single institution from 1978 through 1994. Ann Thorac Surg.1995;60:1331\u20131335","DOI":"10.1016\/0003-4975(95)00617-T"},{"key":"2021121006233310500_R8","doi-asserted-by":"crossref","unstructured":"Heiss KF, Clark RH. Prediction of mortality in neonates with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation. Crit Care Med.1995;23:1915\u20131919","DOI":"10.1097\/00003246-199511000-00019"},{"key":"2021121006233310500_R9","unstructured":"Kassab B, Devonec S, Arnould P, Claris O, Chappuis JP, Thoulon JM. Prenatal diagnosis of congenital diaphragmatic hernia: evaluation of the prognosis. J Gynecol Obstet Biol Reprod (Paris).2000;29:170\u2013175"},{"key":"2021121006233310500_R10","doi-asserted-by":"crossref","unstructured":"Paranka MS, Clark RH, Yoder BA, Null DM Jr. Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure. Pediatrics.1995;95:400\u2013404","DOI":"10.1542\/peds.95.3.400"},{"key":"2021121006233310500_R11","doi-asserted-by":"crossref","unstructured":"Neonatal Inhaled Nitric Oxide Study Group (NINOS). Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. Pediatrics.1997;99:838\u2013845","DOI":"10.1542\/peds.99.6.838"},{"key":"2021121006233310500_R12","doi-asserted-by":"crossref","unstructured":"Lally KP, Paranka MS, Roden J, et al. Congenital diaphragmatic hernia. Stabilization and repair on ECMO. Ann Surg.1992;216:569\u2013573","DOI":"10.1097\/00000658-199211000-00008"},{"key":"2021121006233310500_R13","doi-asserted-by":"crossref","unstructured":"West KW, Bengston K, Rescorla FJ, Engle WA, Grosfeld JL. Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia. Ann Surg.1992;216:454\u2013460","DOI":"10.1097\/00000658-199210000-00009"},{"key":"2021121006233310500_R14","doi-asserted-by":"crossref","unstructured":"Harrison MR, Adzick NS, Bullard KM, et al. Correction of congenital diaphragmatic hernia in utero VII: a prospective trial. J Pediatr Surg.1997;32:1637\u20131642","DOI":"10.1016\/S0022-3468(97)90472-3"},{"key":"2021121006233310500_R15","doi-asserted-by":"crossref","unstructured":"Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital diaphragmatic hernia-a tale of two cities: the Boston experience. J Pediatr Surg.1997;32:401\u2013405","DOI":"10.1016\/S0022-3468(97)90590-X"},{"key":"2021121006233310500_R16","doi-asserted-by":"crossref","unstructured":"Cloutier R, Allard V, Fournier L, Major D, Pichette J, St Onge O. Estimation of lungs\u2019 hypoplasia on postoperative chest x-rays in congenital diaphragmatic hernia. J Pediatr Surg.1993;28:1086\u20131089","DOI":"10.1016\/0022-3468(93)90135-8"},{"key":"2021121006233310500_R17","doi-asserted-by":"crossref","unstructured":"Kays DW, Langham MR Jr, Ledbetter DJ, Talbert JL. Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg.1999;230:340\u2013348","DOI":"10.1097\/00000658-199909000-00007"},{"key":"2021121006233310500_R18","doi-asserted-by":"crossref","unstructured":"Ssemakula N, Stewart DL, Goldsmith LJ, Cook LN, Bond SJ. Survival of patients with congenital diaphragmatic hernia during the ECMO era: an 11-year experience. J Pediatr Surg.1997;32:1683\u20131689","DOI":"10.1016\/S0022-3468(97)90506-6"},{"key":"2021121006233310500_R19","doi-asserted-by":"crossref","unstructured":"Roy BJ, Rycus P, Conrad SA, Clark RH. The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the Extracorporeal Life Support Organization (ELSO) Registry. Pediatrics.2000;106:1334\u20131338","DOI":"10.1542\/peds.106.6.1334"},{"key":"2021121006233310500_R20","doi-asserted-by":"crossref","unstructured":"Nakayama DK, Harrison MR, Chinn DH, et al. Prenatal diagnosis and natural history of the fetus with a congenital diaphragmatic hernia: initial clinical experience. J Pediatr Surg.1985;20:118\u2013124","DOI":"10.1016\/S0022-3468(85)80282-7"},{"key":"2021121006233310500_R21","doi-asserted-by":"crossref","unstructured":"Adzick NS, Harrison MR, Glick PL, Nakayama DK, Manning FA, deLorimier AA. Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases. J Pediatr Surg.1985;20:357\u2013361","DOI":"10.1016\/S0022-3468(85)80219-0"},{"key":"2021121006233310500_R22","doi-asserted-by":"crossref","unstructured":"Lewis DA, Reickert C, Bowerman R, Hirschl RB. Prenatal ultrasonography frequently fails to diagnose congenital diaphragmatic hernia. J Pediatr Surg.1997;32:352\u2013356","DOI":"10.1016\/S0022-3468(97)90209-8"},{"key":"2021121006233310500_R23","doi-asserted-by":"crossref","unstructured":"Chinn DH, Filly RA, Callen PW, Nakayama DK, Harrison MR. Congenital diaphragmatic hernia diagnosed prenatally by ultrasound. Radiology.1983;148:119\u2013123","DOI":"10.1148\/radiology.148.1.6856820"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/110\/3\/590\/1115652\/pe0902000590.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/110\/3\/590\/1115652\/pe0902000590.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:33:48Z","timestamp":1682746428000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/110\/3\/590\/64155\/Survival-in-Early-and-Late-Term-Infants-With"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,9,1]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2002,9,1]]},"published-print":{"date-parts":[[2002,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.110.3.590","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,9,1]]}}}