context: @entity2914 ( @entity2914 ) is considered by most researchers to be a surgical emergency. However, early repair does not necessarily improve respiratory function or reverse fetal circulation, and many @entity1 deteriorate postoperatively. As a result, in 1985, we began to employ a protocol in which surgery was delayed until the PCO2 was maintained below 40 and the @entity1 was hemodynamically stable; @entity1 in whom these criteria could not be achieved died without surgical repair. Sixty-one consecutive @entity1 with @entity2914 were managed over 4 years; 31 from 1983 to 1984 (group 1) and 30 from 1985 to 1986 (group 2). The groups were similar with respect to sex, side of the @entity600 weight, gestational age, incidence of pneumothorax, and blood gases. High frequency oscillation was used with increasing frequency during the study period, for @entity1 with refractory hypercarbia (13% in group 1, 30% in group 2). All @entity1 were initially paralyzed and ventilated. Mean time from admission to surgery was 4.1 hours in group 1 and 24.4 hours in group 2 (P less than .05). In group 1, 87% of @entity1 had surgical repair (77% within eight hours of admission, 10% after eight hours), and in group 2 only 70% of @entity1 had surgery (10% within eight hours, 60% after eight hours). All @entity1 who were not operated on died. Overall mortality was 58% in group 1 and 50% in group 2; this difference was not statistically significant. These data indicate that our current approach has not increased overall mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
  