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Congenital diaphragmatic hernia: are improvements in ECMO & survival sustainable over time?

Journal of Perinatology (2026)Cite this article

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Abstract

Background

Infants with congenital diaphragmatic hernia (CDH) remain at high risk for ECMO and mortality. We previously reported improved outcomes after implementing new CDH care guidelines. This study reassesses ECMO rates, survival, and guideline adherence to determine if improvements persisted.

Methods

Retrospective review of all neonatal CDH cases at a single center during pre-guideline (2003–2015, n = 229) and post-guideline (2016–2024, n = 160) periods, with post-guideline subdivided into two epochs: post-1 (2016–2019, n = 70) and post-2 (2020–2024, n = 90).

Results

Survival without ECMO improved (pre-53%; post-1 74%; post-2 82%; p < 0.001), as did overall survival (72% vs. 83% vs. 86%; p = 0.006). ECMO use decreased (31% vs. 14% vs. 6%; p < 0.001). Inhaled nitric oxide use remained low, and vasoactive medication use dropped significantly in post-2.

Conclusion

Sustained survival improvement and reduced ECMO use followed guideline changes emphasizing minimal stimulation, gentle ventilation, delayed transfer, pre-ductal saturation monitoring, and limited vasoactive therapy.

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Fig. 1
Fig. 2: Survival, survival without ECMO, and ECMO use among neonates with congenital diaphragmatic hernia significantly improved (p < 0.001) over three sequential study periods.

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Data availability

The data that support the findings of this study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Pediatrics/Neonatology, Intermountain Health, Salt Lake City, UT, USA

    Michelle J. Yang, Ryan J. Carpenter, Christian C. Yost & Bradley A. Yoder

  2. University of Utah School of Medicine and Primary Children’s Hospital, Intermountain Health, Salt Lake City, UT, USA

    Michelle J. Yang, Ryan J. Carpenter, Christian C. Yost, Anastasia M. Kahan, Stephen J. Fenton, Katie W. Russell & Bradley A. Yoder

  3. Division of Pediatric Cardiology, Intermountain Health, Salt Lake City, UT, USA

    Ryan J. Carpenter

  4. Molecular Medicine Program, Intermountain Health, Salt Lake City, UT, USA

    Christian C. Yost

  5. Division of Pediatric Surgery, Intermountain Health, Salt Lake City, UT, USA

    Anastasia M. Kahan, Stephen J. Fenton & Katie W. Russell

Authors
  1. Michelle J. Yang
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  2. Ryan J. Carpenter
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  3. Christian C. Yost
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  4. Anastasia M. Kahan
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  5. Stephen J. Fenton
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  6. Katie W. Russell
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  7. Bradley A. Yoder
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Contributions

Drs. Yang and Yoder participated in study design, data analysis, and manuscript writing. Drs. Carpenter, Yost, Kahan, Russell, and Fenton participated in manuscript writing. All authors agree with the final draft of this manuscript.

Corresponding author

Correspondence to Michelle J. Yang.

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Competing interests

The authors declare no competing interests.

Ethics approval

All study methods were performed in accordance with the relevant guidelines and regulations, including institutional, national, and international research standards. Approval for this study was obtained from the University of Utah/Primary Children’s Hospital IRBs, under protocol IRB_00182610, which was determined to be exempt from full review. As part of this exempt determination, the Institutional Review Board granted a waiver of informed consent.

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Yang, M.J., Carpenter, R.J., Yost, C.C. et al. Congenital diaphragmatic hernia: are improvements in ECMO & survival sustainable over time?. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02605-0

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