Congenital diaphragmatic hernia: Survival treated with very delayed surgery, spontaneous respiration, and no chest tube

Wung, Jen Tien; Sahni, Rakesh; Moffitt, Stephen T.; Lipsitz, Evan C.; Stolar, Charles J.H.

doi:10.1016/0022-3468(95)90042-x

Cited by 304 publications

(164 citation statements)

References 20 publications

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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%

“…Switch to conventional ventilation when FiO 2 was <0. 30 Ssemakula (198530 Ssemakula ( -1996 17,20,25,26 In the most recent report, Bagolan et al 16 used HFOV once PIPs were >24 cm H 2 O and sought a hypercapneic state. Two centers demonstrated success using HFOV as initial therapy.…”

Section: Survivalmentioning

confidence: 99%

“…If initial ventilator settings failed to achieve ideal blood gases, another 'acceptable' standard for blood gases was chosen. [16][17][18][19][20]26 If 'acceptable' results were not achieved, patients were switched to high-frequency ventilation (Table 3). 16 (Table 4).…”

Section: Survivalmentioning

confidence: 99%

“…20,[23][24][25]27 None of the centers emergently repaired the defect. Wung et al 26 described an evolution of care, in which the earliest patients were treated with early repair and prophylactic chest tube, and a more recent epoch with delayed repair and no chest tube, noting concurrent improvement in survival. Bagolan et al 16 and Boloker et al specifically noted avoidance of chest tubes, while Kays et al 20 attributed their center's improved survival in Era 3 for using postoperative chest tubes placed in water seal.…”

Section: Congenital Diaphragmatic Hernia Jw Logan Et Almentioning

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: Survivalmentioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

Section: Congenital Diaphragmatic Hernia Jw Logan Et Almentioning

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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The lungs in congenital diaphragmatic hernia: Do we understand?

IJsselstijn

Tibboel

1998

Pediatr. Pulmonol.

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Outcome of congenital diaphragmatic hernia

Beresford

Shaw

2000

Pediatr. Pulmonol.

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The outcome of congenital diaphragmatic hernia (CDH) differs for different stages of the fetus or infant's life (i.e., antenatal, immediate postnatal, and postoperative). Assessing combined data from nonrandomized studies is technically difficult. Following recognized methods of reviewing such trials, we aimed to review the available literature on the outcome of CDH to provide a guide to clinicians when counselling parents who have a fetus/infant with this condition. Thirty‐five studies reporting data for CDH from 1985 to March 1998 were identified using a high sensitive search strategy, hand‐searching journals, and reviewing references of relevant studies. These were systematically reviewed. The median overall mortality was 58% (interquartile range (IQR), 43–65%) for babies diagnosed in utero, 48% (IQR, 35–55%) if born alive, and 33% (IQR, 18–54%) postoperatively. Diagnosis before 25 weeks of gestation is not a uniformly bad prognostic indicator (median mortality, 60%). Outcome was worse for those fetuses with other anomalies (median mortality, 93%). The median percentage mortality for all infants born alive and treated in extracorporeal membrane oxygenation (ECMO) centers was 34% (IQR, 26–47%). Median percentage mortality for all ECMO‐treated infants was 44% (IQR, 35–50%). Different treatment strategies may have a variable impact on outcome. These figures, together with local data, may help in parental counselling on prognosis for fetuses/infants with CDH. Pediatr Pulmonol. 2000; 30:249–256. © 2000 Wiley‐Liss, Inc.

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Congenital diaphragmatic hernia: Survival treated with very delayed surgery, spontaneous respiration, and no chest tube

Cited by 304 publications

References 20 publications

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 lungs in congenital diaphragmatic hernia: Do we understand?

Outcome of congenital diaphragmatic hernia

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