The Effect of Gentle Ventilation on Survival in Congenital Diaphragmatic Hernia

In the September 2003 issue of Pediatrics, Stege et al¹  discuss the effect of new therapies for congenital diaphragmatic hernia (CDH) on survival. They point out that studies reporting improved survival using high-frequency ventilation, extracorporeal membrane oxygenation, inhaled nitric oxide, and delayed surgery are flawed by selection bias and conclude, after assessing 185 cases of CDH from a regional database, that survival is determined principally by the rate of antenatal termination and incidence of associated anomalies. Literature supporting a very promising approach to CDH, gentle ventilation, spearheaded by Wung et al,²  was not presented. In a study reporting 89 consecutive patients with CDH at a single institution, patients treated with gentle ventilation had a 78% overall survival (89% of treated infants survived), compared with 15% and 44% survival during earlier eras in which paralysis, hyperventilation, alkalinization, and extracorporeal membrane oxygenation were used in the absence of gentle...