Aims. We managed in Port-Royal (1985-96) 46 women referred for fetal CDH, and their infants. In Period 1 (< 1992), we used conventional ventilation (CMV) and “early” surgery requiring transport. Since 1992, we prospectively tested: 1) high frequency ventilation (HFO) (± NO); 2) delayed surgery, following stabilization; 3) no transport when switching to CMV was not tolerated (Period 2).

Subjects. 19 infants were treated in Period 1, and 27 infants in Period 2. Birthweight and GA (38 weeks), Pa02/Fi02 at 1 hour of life, and antenatal prognostic indicators were similar in the 2 periods.

Results. In Period 2, as compared with Period 1: 1) the infants were operated later (5.3 days of life, range: 1.3-17: vs 0.4 days. 0.1-1.5), without transport in 55% of the cases; 2) survival increased significantly (17/ 27 = 63%. vs 5 / 19 = 26%: p < 0.05); 3) death after surgery occurred later (day 25. 6-50 vs day 2. 0.5-7). A “honeymoon” period was observed only in Period 1.

Conclusion. In our cohort, survival improved with HFO, delayed surgery and no transport when CMV was not tolerated. Our survival rate following antenatal diagnosis is as good as reported when ECMO is offered.