Chylothorax after congenital diaphragmatic hernia repair: a population-based study

Mills, Jessica; Safavi, Arash; Skarsgard, Erik D.

doi:10.1016/j.jpedsurg.2012.01.031

Cited by 16 publications

(11 citation statements)

References 18 publications

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“…Our data suggest that the incidence of postoperative chylothorax may be higher in those repaired with a patch compared with those repaired primarily. Other authors have also found this to be the case,17–19 whereas others have not 20. The risk of early hernia recurrence in all CDH infants was 6% after primary closure vs 11% in those having a patch.…”

Section: Discussionmentioning

confidence: 89%

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

Long

Bunch

Knight

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo report outcomes to 1 year, in infants born with congenital diaphragmatic hernia (CDH), explore factors associated with infant mortality and examine the relationship between surgical techniques and postoperative morbidity.DesignProspective national population cohort study.SettingPaediatric surgical centres in the UK and Ireland.MethodData were collected to 1 year for infants with CDH live-born between 1 April 2009 to 30 September 2010. Factors associated with infant mortality are explored using logistic regression. Postoperative morbidity following patch versus primary closure, minimally invasive versus open surgery and biological versus synthetic patch material is described. Data are presented as n (%) and median (IQR).ResultsOverall known survival to 1 year was 75%, 95% CI 68% to 81% (138/184) and postoperative survival 93%, 95% CI 88% to 97% (138/148). Female sex, antenatal diagnosis, use of vasodilators or inotropes, being small for gestational age, patch repair and use of surfactant were all associated with infant death. Infants undergoing patch repair had a high incidence of postoperative chylothorax (11/54 vs 2/96 in infants undergoing primary closure) and a long length of hospital stay (41 days, IQR 24–68 vs 16 days, IQR 10–25 in primary closure group). Infants managed with synthetic patch material had a high incidence of chylothorax (11/34 vs 0/19 with biological patch).ConclusionThe majority of infant deaths in babies born with CDH occur before surgical correction. Female sex, being born small for gestational age, surfactant use, patch repair and receipt of cardiovascular support were associated with a higher risk of death. The optimum surgical approach, timing of operation and choice of patch material to achieve lowest morbidity warrants further evaluation.

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Section: Discussionmentioning

confidence: 89%

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

Long

Bunch

Knight

et al. 2019

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

show abstract

“…42 Chylothorax, a known complication of CDH repair, was predicted by the need for preoperative transfusion and preoperative highfrequency oscillatory ventilation, suggesting vulnerability to this complication among infants with the greatest physiologic derangement. 43 The occurrence of abdominal compartment syndrome (ACS), after primary abdominal fascial repair, or the need for delayed fascial closure was predicted by rightsided defects. 44 The small proportion of patients that developed ACS suggested that Canadian surgeons are effectively avoiding this complication by delaying primary fascial closure among those patients at greatest risk.…”

Section: Congenital Diaphragmatic Herniamentioning

confidence: 99%

The Canadian Pediatric Surgery Network (CAPSNet): Lessons Learned from a National Registry Devoted to the Study of Congenital Diaphragmatic Hernia and Gastroschisis

2015

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The Canadian Pediatric Surgery Network (CAPSNet) was created in 2005 by a geographically representative, multidisciplinary group of clinicians and researchers with the intent of establishing a national research registry for gastroschisis (GS) and congenital diaphragmatic hernia (CDH). Since then, CAPSNet has used this registry and its 16-center network to make contributions to the knowledge base informing best practices for GS and CDH care. More recently, CAPSNet has expanded its focus to include quality assurance and improvement at each of its sites, by issuing a benchmarked outcomes "report card" with its annual report. Finally, a major objective of CAPSNet has been to establish and adopt standardized, evidence-based practice guidelines for GS and CDH across all Canadian perinatal centers.

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“…3–8 Chylothorax prolongs duration of ventilation, increases rates of sepsis, cost of care, length of stay, and also prolongs the need for parenteral nutrition and central lines. 3, 6, 8, 9 Postoperative chylothorax contributes significant morbidity to infants with CDH, yet the pathogenesis remains elusive.…”

Section: Introductionmentioning

confidence: 99%

“…Klin et al 11 proposed that visceral herniation obstructs the thoracic duct above the fifth thoracic vertebrae, leading to a back-pressure phenomenon that causes chylothorax through small disruptions in the thoracic duct. Postoperative chylothoraces have also been attributed to increased central venous pressure (secondarily obstructing thoracic duct outflow into the superior vena cava), 9, 12 and aberrant lymphatic development as part of the constellation of defects in CDH.…”

Section: Introductionmentioning

confidence: 99%

Aberrant pulmonary lymphatic development in the nitrofen mouse model of congenital diaphragmatic hernia

Shue

Schecter

et al. 2013

Journal of Pediatric Surgery

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Purpose Many infants develop a postsurgical chylothorax after diaphragmatic hernia repair. The pathogenesis remains elusive but may be due to dysfunctional lymphatic development. This study characterizes pulmonary lymphatic development in the nitrofen mouse model of CDH. Methods CD1 pregnant mice were fed nitrofen/bisdiamine (N/B) or olive oil at E8.5. At E14.5 and E15.5, lung buds were categorized by phenotype: normal, N/B without CDH (N/B−CDH), or N/B with CDH (N/B+CDH). Anti-CD31 was used to localize all endothelial cells, while anti-LYVE-1 was used to identify lymphatic endothelial cells in lung buds using immunofluorescence. Differential protein expression of lymphatic-specific markers was analyzed. Results Lymphatic endothelial cells localized to the mesenchyme surrounding the airway epithelium at E15.5. CD31 and LYVE-1 colocalization identified lymphatic endothelial cells. LYVE-1 expression was upregulated in N/B+CDH lung buds in comparison to N/B−CDH and normal lung buds by immunofluorescence. Western blotting shows that VEGF-D, LYVE-1, Prox-1, and VEGFR-3 expression was upregulated in N/B+CDH lung buds in comparison to N/B−CDH or control lung buds at E14.5. Conclusions Lung lymphatics are hyperplastic in N/B+CDH. Upregulation of lymphatic-specific genes suggest that lymphatic hyperplasia plays an important role in dysfunctional lung lymphatic development in the nitrofen mouse model of CDH.

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Chylothorax after congenital diaphragmatic hernia repair: a population-based study

Cited by 16 publications

References 18 publications

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

The Canadian Pediatric Surgery Network (CAPSNet): Lessons Learned from a National Registry Devoted to the Study of Congenital Diaphragmatic Hernia and Gastroschisis

Aberrant pulmonary lymphatic development in the nitrofen mouse model of congenital diaphragmatic hernia

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