Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair

Boloker, Judd; Bateman, David A.; Wung, Jen-Tien; Stolar, Charles J.H.

doi:10.1053/jpsu.2002.30834

Cited by 404 publications

(314 citation statements)

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“…While there is no overlap in the reports from the Boston group, there is a small overlap in the outcomes reports from the Columbia group (August 1992 through December 1995). 15,17,25,26 This overlap was not considered in the analysis, as data could not be appropriately extracted from the reports and omission of either or both of the reports seemed inappropriate.…”

Section: Resultsmentioning

confidence: 99%

“…16 Quality of included studies Our search identified retrospective, single-center case series or case vs historical control comparisons, raising the possibility of both selection and performance bias. [16][17][18][19][20][21][22][23][24][25][26][27] The improvement in outcomes noted in reports comparing serial epochs are accompanied by reports of changes in clinical practice. Details of various practices (specifics of antenatal care, ventilation strategy, PPHN management strategy and use of ECMO) were not uniformly recorded in all studies.…”

Section: Selection Criteriamentioning

confidence: 99%

“…4 Literature review reveals a limited number of controlled clinical trials examining interventions that improve survival of infants with CDH; [5][6][7][8][9][10][11][12][13][14] however, several centers reporting relatively high rates of survival for CDH have described their management strategies in varying detail. [15][16][17][18][19][20][21][22][23][24][25] The objective of this report is to provide clinicians with a summary of specific details of clinical care strategies from these 'benchmark' centers. In the absence of clinical trials, this summary of practice strategies provides a starting point for development of an approach to care for infants with CDH.…”

Section: Introductionmentioning

confidence: 99%

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Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies

et al. 2007

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Objectives: Recent reports suggest that specific care strategies improve survival of infants with congenital diaphragmatic hernia (CDH). This review presents details of care from centers reporting high rates of survival among CDH infants.Study Design: We conducted a MEDLINE search (1995 to 2006) and searched all citations in the Cochrane Central Register of Controlled Trials. Studies were included if they contained reports of >20 infants with symptomatic CDH, and >75% survival of isolated CDH.Result: Thirteen reports from 11 centers met inclusion criteria. Overall survival, including infants with multiple anomalies, was 603/763 (79%; range: 69 to 93%). Survival for isolated CDH was 560/661 (85%; range: 78 to 96%). The frequency of extracorporeal membrane oxygenation (ECMO) use for isolated CDH varied widely among reporting centers 251/622 (40%; range: 11 to 61%), as did survival for infants with isolated CDH placed on ECMO: 149/206 (73%; range: 33 to 86%). There was no suggestion of benefit from use of antenatal glucocorticoids given after 34 weeks gestation or use of postnatal surfactant. Low mortality was frequently attributed to minimizing lung injury and adhering to center-specific criteria for ECMO.Conclusion: Use of strategies aimed at minimizing lung injury, tolerance of postductal acidosis and hypoxemia, and adhering to center-specific criteria for ECMO were strategies most consistently reported by successful centers. The literature lacks randomized clinical trials of these or other care strategies in this complex patient population; prospective studies of safety and long-term outcome are needed. Keywords: congenital diaphragmatic hernia; pulmonary hypertension; pulmonary hypoplasia; inhaled nitric oxide; extracorporeal membrane oxygenation; systematic review Introduction Congenital diaphragmatic hernia (CDH) is a rare malformation observed in approximately 1 in 3000 live births, with estimates of postnatal survival ranging from 50 to 70% despite advances in neonatal care. 1 The combination of pathophysiologic derangements associated with CDH, including lung hypoplasia, lung dysmaturity and pulmonary hypertension (PPHN), requires a multidisciplinary approach to care. 2,3 The complex nature of clinical management and the relatively infrequent presentation of infants with this rare malformation to single centers has lead to difficulty identifying consistent strategies for CDH management. A recent report from the Canadian Neonatal Research Network indicates better than predicted survival in Network centers, with significant improvement in the higher mortality odds strata, and 90% survival in the three centers that cared for at least 12 infants over a 22-month period. Details of management strategies are not provided, but the report suggests that survival is best achieved by caring for CDH infants at centers that have developed a standardized approach to care, with adequate numbers of CDH infants to develop expertise. 4 Literature review reveals a limited number of controlled clinical trials examining inter...

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Section: Resultsmentioning

confidence: 99%

Section: Selection Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies

et al. 2007

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“…This ventilator-induced lung injury due to high pressure ventilation appears to be one of the major contributors to mortality in CDH patients [4,49,52,53] and therefore the strategy of high pressure ventilation has been abandoned. Since the introduction of ''permissive hypercapnia'' (i.e, allowing higher concentrations of carbon dioxide in the blood to prevent barotrauma), an improved survival rate has been documented [4,19,49,52]. Nevertheless, barotrauma is still an important contributing factor to lung injury, which could possibly be further reduced by the use of ECMO [28].…”

Section: Pulmonary Morbiditymentioning

confidence: 99%

“…Delayed surgery is theorized to provide additional time for remodeling of the pulmonary vasculature, leading to a more stable infant, who is better able to tolerate a postoperative decrease in compliance [16,19]. Although a significant change in survival after the introduction of delayed surgery was not observed [4,[20][21][22], a strategy of delaying correction of the defect for some period of time have been adopted by centers, with the majority of patients undergoing operation beyond 24 h of age [23,24].…”

Section: Introductionmentioning

confidence: 99%

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

et al. 2008

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Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly with a mortality rate of approximately 40-50%, depending on case selection. It has been suggested that new therapeutic modalities such as nitric oxide (NO), high frequency oxygenation (HFO) and extracorporal membrane oxygenation (ECMO) might decrease mortality associated with pulmonary hypertension and the sequelae of artificial ventilation. When these new therapies indeed prove to be beneficial, a larger number of children with severe forms of CDH might survive, resulting in an increase of CDH-associated complications and/or consequences. In follow-up studies of infants born with CDH, many complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to thrive, neurocognitive defects and musculoskeletal abnormalities have been described. Long-term pulmonary morbidity in CDH consists of obstructive and restrictive lung function impairments due to altered lung structure and prolonged ventilatory support. CDH has also been associated with persistent pulmonary vascular abnormalities, resulting in pulmonary hypertension in the neonatal period.

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Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants

Moyer

Moya

Tibboel

et al. 2000

Cochrane Database of Systematic Reviews

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Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair

Cited by 404 publications

References 1 publication

Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies

Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants

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