Stability prior to surgery in Congenital Diaphragmatic Hernia: Is it necessary?

Alana L. Beres, Pramod S. Puligandla, Mary E. Brindle

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


AbstractBackground Delaying surgery for infants with CDH until they achieve clinical stability is common practice. Stability, however, is inconsistently defined, and many infants fail to reach pre-established criteria. We sought to determine if infants undergoing surgery without meeting pre-established criteria could achieve meaningful survival. Methods All infants in the CAPSNet database were analyzed (2005-2010). Patients undergoing operative repair were divided into two groups based on whether they met strict (FiO2 < 0.40, conventional ventilation, preductal saturation > 92%, no inotropes or vasodilators), or lenient (FiO2 < 0.60, conventional ventilation, preductal saturation > 88%, no vasodilators) criteria. Univariate analyses were performed comparing characteristics of those who survived after surgery (N = 273) with those who did not (N = 21). Results 294 patients (85%) survived to surgery. Predictors of post-operative survival included prenatal liver position (p = 0.003), preoperative oxygen requirements (p = 0.008), preoperative inotropes (p < 0.0001), and non-conventional ventilation (p = 0.004). Infants meeting strict criteria had increased survival (99%; p < 0.0001). Infants meeting lenient criteria constituted 70% of survivors. Nearly one-third of survivors met neither strict nor lenient criteria. Conclusions Infants with CDH can achieve good survival even when criteria for pre-operative stability are not met. We suggest that all infants should be repaired even if lenient criteria for ventilatory, inotrope, or vasodilator requirements are not achieved.

Original languageEnglish (US)
Pages (from-to)919-923
Number of pages5
JournalJournal of Pediatric Surgery
Issue number5
StatePublished - May 2013


  • Congenital Diaphragmatic Hernia
  • Operative repair
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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