Protocolized approach to the management of congenital diaphragmatic hernia: benefits of reducing variability in care.

Journal Article (Journal Article)

PURPOSE: Variable approaches to the care of infants with congenital diaphragmatic hernia (CDH) by multiple providers may contribute to inconsistent care. Our institution developed a comprehensive evidence-based protocol to standardize the management of CDH infants. This report reviews patient outcomes before and after the implementation of the protocol. METHODS: Retrospective chart review of CDH infants managed with individualized care (preprotocol group, January 1997-December 2001, n = 22) or on the protocol (Protocol group, January 2002-July 2009, n = 47). Survival and other categorical variables were compared by chi(2) analysis, and continuous variables were compared using 1-sided analysis of variance analysis, with significance defined as P < .05. RESULTS: Survival to discharge was significantly greater in the Protocol group (40/47; 85%) than the preprotocol group (12/22; 52%; P = .006), although mean gestational age, mean birth weight, and expected survival were not statistically different between the 2 groups. The use of supportive therapies, including high-frequency jet ventilation, inhaled nitric oxide, and extracorporeal life support, was similar between groups as well. CONCLUSIONS: Since the implementation of a management protocol for infants with CDH, survival has improved significantly compared with expected survival and preprotocol controls. Reduction in the variability of care through use of an evidence-based protocol may improve the survival of CDH infants.

Full Text

Duke Authors

Cited Authors

  • Tracy, ET; Mears, SE; Smith, PB; Danko, ME; Diesen, DL; Fisher, KA; Hoehner, JC; Goldberg, RN; Cotten, CM; Rice, HE

Published Date

  • June 2010

Published In

Volume / Issue

  • 45 / 6

Start / End Page

  • 1343 - 1348

PubMed ID

  • 20620342

Pubmed Central ID

  • PMC3318997

Electronic International Standard Serial Number (EISSN)

  • 1531-5037

Digital Object Identifier (DOI)

  • 10.1016/j.jpedsurg.2010.02.104


  • eng

Conference Location

  • United States