692 py was observed after adjusting for initial clinical character- istics. The improved survival of neonates with CDH seems to be associated with an improved postoperative survival rate after the introduction of iNO therapy. We speculate that a management strategy based on iNO therapy and delayed operation, rather than differences between the initial clini- cal characteristics of the two study groups, might have par- tially contributed to the improvements observed in postop- erative and overall survival rates in neonates with CDH. REFERENCES 1. Weinstein S, Stolar CJ. Newborn surgical emergency, congenital diaphragmatic hernia and extracorporeal membrane oxygenation. Pediatr Clin North Am 1993; 40: 1315-33. 2. Clark RH, Hardin WD Jr, Hirschl RB, Jaksic T, Lally KP, Langham MR Jr, Wilson JM. Current surgical management of congenital dia- phragmatic hernia: a report from the congenital diaphragmatic her- nia study group. J Pediatr Surg 1998; 33: 1004-9. 3. Beresford MW, Shaw NJ. Outcome of congenital diaphragmatic hernia. Pediatr Pulmonol 2000; 30: 249-56. 4. The Congenital Diaphragmatic Hernia Study Group. Estimating dis- ease severity of congenital diaphragmatic hernia in the first 5 min- utes of life. J Pediatr Surg 2001; 36: 141-5. 5. The Neonatal Inhaled Nitric Oxide Study Group (NINOSG). Inhaled nitric oxide and hypoxic respiratory failure in infants with congeni- tal diaphragmatic hernia. Pediatrics 1997; 99: 838-45. 6. Lally KP. Congenital diaphragmatic hernia. Curr Opin Pediatr 2002; 14: 486-90. 7. Downard CD, Wilson JM. Current therapy of infants with congeni- tal diaphragmatic hernia. Sem in Neonatol 2003; 8: 215-21. 8. Dimitriou G, Greenough A, Kavvadia V, Devane SP, Rennie JM. Outcome predictors in nitric oxide treated preterm infants. Eur J Pediatr 1999; 158: 589-91. 9. Dillon E, Renwick M, Wright C. Congenital diaphragmatic hernia: antenatal detection and outcome. Br J Radiol 2000; 73: 360-5. 10. Dubois A, Storme L, Jaillard S, Truffert P, Riou Y, Rakza T, Pierrat V, Gottrand F, Pruvot FR, Leclerc F, Lequien P. Congenital hernia of the diaphragm. A retrospective study of 123 cases recorded in the Neonatal Medicine Department, URHC in Lille between 1985 and 1996. Arch Pediatr 2000; 7: 132-42. 11. Reickert CA, Hirschl RB, Atkinson JB, Dudell G, Georgeson K, Glick P, Greenspan J, Kays D, Klein M, Lally KP, Mahaffey S, Ryckman F, Sawin R, Short BL, Stolar CJ, Thompson A, Wilson JM. Congen- ital diaphragmatic hernia survival and use of extracorporeal life sup- port at selected level III nurseries with multimodality support. Surgery 1998; 123: 305-10. 12. Skari H, Bjornland K, Haugen G, Egeland T, Emblem R. Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pedi- atr Surg 2000; 35: 1187-97. 13. Boloker J, Bateman DA, Wung JT, Stolar CJ. Congenital diaphrag- matic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg D.-H. Kim, J.D. Park, H.-S. Kim, et al. 2002; 37: 357-66. 14. Bedoyan JK, Blackwell SC, Treadwell MC, Johnson A, Klein MD. Congenital diaphragmatic hernia: associated anomalies and ante- natal diagnosis. Pediatr Surg Int 2004; 20: 170-6. 15. Betremieux P, Gaillot T, de la Pintiere A, Beuchee A, Pasquier L, Habonimana E, Le Bouar G, Branger B, Milon J, Fremond B, Wodey E, Odent S, Poulain P, Pladys P. Congenital diaphragmatic hernia: prenatal diagnosis permits immediate intensive care with high sur- vival rate in isolated cases. A population-based study. Prenat Diagn 2004; 24: 487-93. 16. Adzick NS, Vacanti JP, Lillehei CW, O’Rourke PP, Crone RK, Wil- son JM. Fetal diaphragmatic hernia: ultrasound and clinical outcome in 38 cases. J Pediatr Surg 1989; 24: 654-8. 17. Albanese CT, Lopoo J, Goldstein RB, Filly RA, Feldstein VA, Calen PW, Jennings RW, Farrell JA, Harrison MR. Fetal liver position and perinatal outcome for congenital diaphragmatic hernia. Perinat Diagn 1998; 18: 1138-42. 18. Laudy JA, Van Gucht M, Van Dooren MF, Wladimiroff JW, Tibboel D. Congenital diaphragmatic hernia: an evaluation of the prognos- tic value of the lung-to-head ratio and other prenatal parameters. Prenat Diagn 2003; 23: 634-9. 19. Kinsella JP, Truog WE, Walsh WF, Goldberg RN, Bancalari E, May- ock DE, Redding GJ, deLemos RA, Sardesai S, McCurnin DC, More- land SG, Cutter GR, Abman SH. Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn. J Pedi- atr 1997; 131: 55-62. 20. Bohn DJ, Pearl R, Irish MS, Glick PL. Postnatal management of congenital diaphragmatic hernia. Clin Perinatol 1996; 23: 843-72. 21. Henneberg SW, Jepsen S, Andersen PK, Pedersen SA. Inhalation of nitric oxide as a treatment of pulmonary hypertension in congeni- tal diaphragmatic hernia. J Pediatr Surg 1995; 30: 853-5. 22. Karamanoukian HL, Glick PL, Zayek M, Steinhorn RH, Zwass MS, Fineman JR, Morin FC 3rd. Inhaled nitric oxide in congenital hypo- plasia of the lungs due to diaphragmatic hernia or oligohydramnios. Pediatrics 1994; 94: 715-8. 23. Okuyama H, Kubota A, Oue T, Kuroda S, Ikegami R, Kamiyama M, Kitayama Y, Yagi M. Inhaled nitric oxide with early surgery improves the outcome of antenatally diagnosed congenital diaphrag- matic hernia. J Pediatr Surg 2002; 37: 1188-90. 24. Reyes C, Chang LK, Waffarn F, Mir H, Warden MJ, Sills J. Delayed repair of congenital diaphragmatic hernia with early high-frequen- cy oscillatory ventilation during preoperative stabilization. J Pedi- atr Surg 1998; 33: 1010-4. 25. Stege G, Fenton A, Jaffray B. Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia, Pediatrics 2003; 112: 532-5. 26. Okazaki T, Kohno S, Hasegawa S, Urushihara N, Yoshida A, Kawano S, Saito A, Tanaka Y. Congenital diaphragmatic hernia: efficacy of ultrasound examination in its management. Pediatr Surg Int 2003; 19: 176-9. 27. Bagolan P, Casaccia G, Crescenzi F, Nahom A, Trucchi A, Gior- landino C. Impact of a current treatment protocol on outcome of high-risk congenital diaphragmatic hernia. J Pediatr Surg 2004; 39: 313-8.