A single-center observational study on congenital diaphragmatic hernia: Outcome, predictors of mortality and experience from a tertiary perinatal center in Singapore

Teo, Wan-Yee; Sriram, Bhavani; Alim, AA Abdul; Ruan, Xucong; Rajadurai, Victor Samuel

doi:10.1016/j.pedneo.2020.03.003

Cited by 6 publications

(10 citation statements)

References 30 publications

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“…Finally, 90 studies were included in this review, reporting on 24,930 children with CDH (Table ). This included 83 case series 15,17−21,33‐110 , four cohort studies, 16,111‐113 and three randomized controlled trials 7,114,115 . Nine studies reported only on isolated CDH cases 7,21,52,76,85,91,104,105,109 and in four studies a differentiation was made between isolated and nonisolated cases 39,51,81,94 …”

Section: Resultsmentioning

confidence: 99%

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

et al. 2021

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Background: Congenital diaphragmatic hernia (CDH) reportedly has neurologic consequences in childhood however little is known about the impact in isolated CDH.Aims: Herein we aimed to describe the risk of neurodevelopmental complications in children born with isolated CDH. Materials & Methods:We systematically reviewed literature for reports on the neurological outcome of infants born with isolated CDH. The primary outcome was neurodevelopmental delay. Secondary outcomes included, motor skills, intelligence, vision, hearing, language and behavior abnormalities.Results: Thirteen out of 87 (15%) studies reported on isolated CDH, including 2624 out of 24,146 children. Neurodevelopmental delay was investigated in four studies and found to be present in 16% (3-34%) of children. This was mainly attributed to motor problems in 13% (2-30%), whereas cognitive dysfunction only in 5% (0-20%) and hearing in 3% (1-7%). One study assessed the effect of fetal surgery. When both isolated and non-isolated children were included, these numbers were higher. Discussion: This systematic review demonstrates that only a minority of studies focused on isolated CDH, with neurodevelopmental delay present in 16% of children born with CDH. Conclusion:To accurately counsel patients, more research should focus on isolated CDH cases and examine children that underwent fetal surgery. Lennart Van der Veeken and Simen Vergote shared first authorship. #Jan Deprest and Matteo Bruschettini shared last authorship.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Resultsmentioning

confidence: 99%

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

et al. 2021

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“…Two further papers 26,27 investigated rates of bronchiolitis in CDH infants at their centres but neither included a comparison group, so are not included in this final analysis. Teo et al, 26 a study from Singapore, notably, found the rates of bronchiolitis hospitalisation (not RSV proven) to be 33% (8/24). Masumoto et al, 27 a study from Japan, found the rates of RSV bronchiolitis hospitalisation to be 14% (3/21).…”

Section: Resultsmentioning

confidence: 99%

“…Titles and abstracts of selected papers were then assessed in full for eligibility, excluding 29 papers. Ten publications 21–30 remained, from which 7 more papers 21–27 were subsequently excluded (see Table for reasons for exclusion) We included 3 final studies, 28–30 all of which were retrospective cohorts. Figure 1 shows the PRISMA flowchart for the current study.…”

Section: Resultsmentioning

confidence: 99%

Respiratory syncytial virus bronchiolitis in congenital diaphragmatic hernia: A systematic review of prevalence rates and palivizumab prophylaxis

Lewis

Sinha

Losty

2021

Pediatric Pulmonology

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Background: The seasonality of respiratory syncytial virus (RSV) epidemics have been disrupted during the COVID-19 pandemic, possibly because of lockdowns and social restrictions reducing viral transmission. Given uncertainties around the severity of upcoming RSV bronchiolitis epidemics, debate exists whether palivizumab (RSV prophylaxis) should be administered to infants with Congenital Diaphragmatic Hernia (CDH), who may be vulnerable due to lung hypoplasia and pulmonary hypertension.Aim: To evaluate (1) if CDH infants have higher risk of admission with RSV bronchiolitis than infants in the general population; (2) if palivizumab prophylaxis may reduce this risk. Methods:We included all eligible studies examining the risk(s) of RSV-positive bronchiolitis requiring hospital admission in (1) CDH infants without palivizumab prophylaxis versus infants in the general population and (2) CDH infants with prophylaxis versus CDH infants without prophylaxis. The primary outcome evaluated was the risk of admission with RSV bronchiolitis. Data are reported descriptively and meta-analysed when appropriate.Results: Three eligible retrospective cohort studies were identified: one study found CDH to be an independent risk factor for RSV hospitalisation (odds ratio, 3.30; 95% confidence interval [CI], 2.01-4.4); two studies compared RSV hospitalisation rates in CDH patients who had palivizumab versus those that did not. The pooled risk ratio was 1.11 (95% CI, 0.29-4.23; p = .88). Overall, the quality of evidence was considered poor and one study was industry funded. Conclusion:Whether CDH infants are at particular risk of severe bronchiolitis remains unclear. There is no evidence from this current systematic review that CDH infants should routinely receive palivizumab vaccination prophylaxis.

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“…Pulmonary hypoplasia and pulmonary hypertension are major determinants of mortality in infants with CDH [4]. Pulmonary hypoplasia severity can result in alterations in arterial blood gases [5][6][7] and this is reflected in a high oxygenation index (OI). The best oxygenation index on day 1 (BOId1) after birth was associated with better survival in CDH infants [8].…”

Section: Introductionmentioning

confidence: 99%

Prediction of survival in infants with congenital diaphragmatic hernia and the response to inhaled nitric oxide

et al. 2022

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The use of inhaled nitric oxide (iNO) in treating pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH) is controversial. Our aims were to identify factors associated with survival in CDH infants and whether this was influenced by the response to iNO. Results of CDH infants treated in a tertiary surgical and medical perinatal centre in a ten year period (2011–2021) were reviewed. Factors affecting survival were determined. To assess the response to iNO, blood gases prior to and 30 to 60 min after initiation of iNO were analysed and PaO2/FiO2 ratios and oxygenation indices (OI) calculated. One hundred and five infants were admitted with CDH; 46 (43.8%) infants died. The CDH infants who died had a lower median observed to expected lung to head ratio (O/E LHR) (p < 0.001) and a higher median highest OI on day 1 (HOId1) (p < 0.001). HOId1 predicted survival after adjusting for gestational age, Apgar score at 5 min and O/E LHR (odds ratio 0.948 (95% confidence intervals 0.913–0.983)). Seventy-two infants (68.6%) received iNO; 28 survived to discharge. The median PaO2 (46.7 versus 58.8 mmHg, p < 0.001) and the median PaO2/FiO2 ratio (49.4 versus 58.8, p = 0.003) improved post iNO initiation. The percentage change in the PaO2/FiO2 ratio post iNO initiation was higher in infants who survived (69.4%) compared to infants who died (10.2%), p = 0.018.Conclusion: The highest OI on day 1 predicted survival. iNO improved oxygenation in certain CDH infants and a positive response was more likely in those who survived. What is Known:• The use of iNO is controversial in infants with CDH with respect to whether it improves survival. What is New:• We have examined predictors of survival in CDH infants including the response to iNO and demonstrated that the highest oxygenation index on day 1 predicted survival (AUCROC =0.908).• Certain infants with CDH responded to iNO and those with a greater response were more likely to survive.

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A single-center observational study on congenital diaphragmatic hernia: Outcome, predictors of mortality and experience from a tertiary perinatal center in Singapore

Cited by 6 publications

References 30 publications

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

Respiratory syncytial virus bronchiolitis in congenital diaphragmatic hernia: A systematic review of prevalence rates and palivizumab prophylaxis

Prediction of survival in infants with congenital diaphragmatic hernia and the response to inhaled nitric oxide

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