Congenital Diaphragmatic Hernia Stabilization and Repair on ECMO

Lally, Kevin P.; Paranka, Michael S.; Roden, Jay S.; Georgeson, Keith E.; Wilson, Jay M.; Lillehei, C. Walton; Breaux, Charles W.; Poon, Michael W.; Clark, Reese H.; Atkinson, James B.

doi:10.1097/00000658-199211000-00008

Cited by 137 publications

(54 citation statements)

References 20 publications

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“…The single-most important predictor of hernia recurrence is the presence of a large defect that requires a patch to repair. 2,6,42,43 Recurrences can present from months to years after the initial hospitalization, or the patient can remain asymptomatic. Detection of recurrences may be discovered incidentally on chest radiographs performed for surveillance or other reasons.…”

Section: Hearing Lossmentioning

confidence: 99%

Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia

Newborn¹,

Lally²,

Engle³

2008

Pediatrics

225

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Infants with congenital diaphragmatic hernia often require intensive treatment after birth, have prolonged hospitalizations, and have other congenital anomalies. After discharge from the hospital, they may have long-term sequelae such as respiratory insufficiency, gastroesophageal reflux, poor growth, neurodevelopmental delay, behavior problems, hearing loss, hernia recurrence, and orthopedic deformities. Structured follow-up for these patients facilitates early recognition and treatment of these complications. In this report, follow-up of infants with congenital diaphragmatic hernia is outlined. INTRODUCTIONSurvival rates for patients with congenital diaphragmatic hernia (CDH) have increased during the past decade with the implementation of more "gentle" ventilation and physiology-specific strategies, high-frequency ventilation, extracorporeal membrane oxygenation (ECMO), and improved supportive care. 1-3 Improvement in survival rates has occurred for infants with CDH complicated by severe pulmonary hypoplasia, pulmonary hypertension, and chronic lung disease. 4 However, other significant morbidities, such as neurocognitive delay, gastroesophageal reflux, hearing loss, chest wall deformity, poor growth, hernia recurrence, and complications attributable to associated congenital anomalies, continue to affect the lives of many infants with CDH beyond the neonatal period. 1,5,6 Coordination of the complex medical and surgical needs of these infants is challenging. Comprehensive multispecialty clinics that aggregate specialty physicians and services are family-friendly and provide for collaborative evaluation and management planning. Same-site multidisciplinary service teams also improve coordination, communication, and support for the medical home pediatrician who is responsible for managing the general health care needs of the infant. Unfortunately, such multispecialty clinics are not available to all infants with CDH. The following information is intended to provide clinicians who care for infants with CDH with a template to organize a comprehensive plan for detection and management of associated morbidities. PULMONARY MORBIDITYSurvivors with CDH may require treatment beyond the initial hospitalization for chronic lung disease, bronchospasm, pulmonary hypertension, aspiration, pneumonia, and pulmonary hypoplasia. Oxygen treatment beyond the initial hospitalization may be needed for many of these infants, especially those who are treated with ECMO and a prosthetic patch. 7-9 Many survivors not treated with ECMO also receive bronchodilators and inhaled steroids. 8 At least 4% of survivors require a long-term tracheostomy. 9,10 Nearly one fourth of infants with CDH who survive have obstructive airway disease at 5 years of age, 10,11 and some have pulmonary hypertension that persists for months or years. Pulmonary hypertension that persists for more than the first few weeks after birth is a risk factor for early death. 12 Persistent abnormalities in lung function also have been demonstrated on ventilation/per...

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Section: Hearing Lossmentioning

confidence: 99%

Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia

Newborn¹,

Lally²,

Engle³

2008

Pediatrics

225

View full text Add to dashboard Cite

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“…Quality clinical evidence to support many of these modalities is limited. Most outcome data are reported from either single-center experiences [93][94][95] , hospital databases [96] , or network registries [97][98][99] . There remains a limited number of prospective controlled clinical trials that examine various interventions for infants with CDH [13,14,28,[100][101][102][103][104][105][106] .…”

Section: Resultsmentioning

confidence: 99%

Surgical Management of the Newborn with Congenital Diaphragmatic Hernia

Tsao

Lally

2010

Fetal Diagn Ther

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Despite advances in the surgical treatment and medical management over the last 20 years, neonates with congenital diaphragmatic hernia (CDH) remain one of the most challenging patient groups for all clinicians. Treatment strategies have shifted from emergent surgical repair and maximum ventilatory support to delayed repair and preoperative hemodynamic stabilization with lung-sparing ventilation strategies and extracorporeal membrane oxygenation. Subsequently, overall survival has improved to as high as 80% in some centers. However, specific treatment criteria are vague and highly variable amongst centers. This lack of consensus of these treatment modalities remains elusive due to the heterogeneity in disease severity as well as heterogeneity in patient care amongst centers. As a result of the rare incidence of disease and limited experience of individual centers, the evidence for CDH is typically reported as a homogenous disease largely supported by case series and networked-based studies. To better evaluate the data and compare treatment strategies, a classification and stratification of disease and centers is needed.

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“…Neonates underwent elective hernia repair by 1 of 8 staff pediatric surgeons, with standard perioperative care based on minimal barotrauma, permissive hypercapnea and, if necessary, early use of extracorporeal membrane oxygenation (ECMO), as previously described [13,14] . Primary closure was the preferred method of repair of the hernia.…”

Section: Methodsmentioning

confidence: 99%

Liver Position Is a Prenatal Predictive Factor of Prosthetic Repair in Congenital Diaphragmatic Hernia

Kunisaki¹,

Barnewolt

Estroff

et al. 2008

Fetal Diagn Ther

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Objective: To determine whether any common maternal-fetal variable has prenatal predictive value of prosthetic repair in congenital diaphragmatic hernia. Methods: This was a 5-year single-center retrospective review of fetal congenital diaphragmatic hernia referrals. Multiple prenatal variables were correlated with the need for a prosthetic repair. Statistical analyses were by Fisher’s exact and Mann-Whitney U-tests, as appropriate (p < 0.05). Results: Fetal liver position was a predictor of prosthetic repair. The presence or absence of liver herniation was correlated with prosthetic repair rates of 83.3 and 23.1%, respectively (p < 0.001). All patients with moderate/severe liver herniation required a prosthetic patch. Conclusion: Liver herniation has prenatal predictive value for the need for prosthetic repair in congenital diaphragmatic hernia. This finding should be valuable during prenatal counseling for clinical trials of engineered diaphragmatic repair.

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Congenital Diaphragmatic Hernia Stabilization and Repair on ECMO

Cited by 137 publications

References 20 publications

Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia

Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia

Surgical Management of the Newborn with Congenital Diaphragmatic Hernia

Liver Position Is a Prenatal Predictive Factor of Prosthetic Repair in Congenital Diaphragmatic Hernia

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