Mortality among infants with high-risk congenital diaphragmatic hernia in Singapore

Chan, Daisy Kwai Lin; Ho, Lai Yun; Joseph, V. T.

doi:10.1016/s0022-3468(97)90104-4

Cited by 18 publications

(21 citation statements)

References 26 publications

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“…Thirty-five studies remained for further analysis, having fulfilled our predefined inclusion and exclusion criteria. 2,3,6,7,9,13,22,23,32, Of these studies, 7 were prospective, 17 reported data from ECMO centers, 16 from tertiary centers, and 2 gave multicenter outcome data. The median time for which data were collected in the studies was 5 years (range, 2-12 years).…”

Section: Resultsmentioning

confidence: 99%

“…1 Despite advances in obstetric management, neonatal care, and surgical intervention, as well as the advent of new supportive measures such as extracorporeal membrane oxygenation (ECMO) support, the mortality from CDH remains high. [2][3][4][5][6][7][8][9][10][11][12] Many clinicians may be involved in the care of the newly diagnosed fetus or infant and therefore in the counselling of parents. Awareness of the outcome of CDH is crucial in order to be able to give parents appropriate information regarding prognosis.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of congenital diaphragmatic hernia

Beresford

Shaw

2000

Pediatr. Pulmonol.

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“…The prenatal detection rate for CDH varies enormously in published studies, from 10% 12 to 79%, 35 reflecting differences in local protocols of prenatal care and variable sonographic expertise. In our study, we do not know how many of the postnatally diagnosed infants had prenatal scans; therefore, the false-negative rate cannot be determined.…”

Section: Prenatal Diagnosismentioning

confidence: 99%

Outcomes of Congenital Diaphragmatic Hernia: A Population-Based Study in Western Australia

Colvin¹,

et al. 2005

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ABSTRACT.Objectives. There have been many recent reports of improved survival rates for congenital diaphragmatic hernia (CDH), largely derived from institution-based data. These are often flawed by case selection bias. The objectives of this study were to document the true incidence, management, and outcomes of CDH in a geographically defined population over a 12-year period and to determine the changing trends in these over time. We also sought to ascertain the prenatal and postnatal factors associated with morbidity and death among these infants.Methods. A retrospective study of all cases of CDH in Western Australia from 1991 to 2002 was conducted. Cases were identified from 5 independent databases within the Western Australian health network, including the Western Australian Birth Defects Registry. All fetuses and neonates diagnosed with CDH in Western Australia during this period were identified, including miscarriages, stillbirths, and terminations of pregnancies in which a diagnosis of fetal CDH had been made, as well as those diagnosed postnatally. Cases not known to involve CDH until diagnosis at autopsy were also included. Infants with diaphragmatic eventration were excluded from the study. Detailed information was obtained from review of maternal and infant medical records.Results. One hundred sixteen cases of CDH were identified. Of these, 71 (61%) infants were born alive and 37 survived beyond 1 year of age (52% of live-born infants, 32% of all cases of CDH). Pregnancies involving 38 (33%) fetuses were terminated electively, 4 (3%) fetuses were aborted spontaneously, and 3 (3%) fetuses were stillborn. Another major congenital anomaly was present in 54 (47%) cases. Twenty-one (18%) cases had other anomalies that were likely to be fatal. Of all cases with an additional major anomaly, 42 (78%) died. Twenty-seven (71%) of 38 fetuses for whom the pregnancy was terminated had another major anomaly. Twenty-three (32%) live-born infants had another major anomaly (4 of which were considered fatal conditions); however, this did not affect their survival rates. Fifty-three percent of cases were diagnosed prenatally, and 49% of these pregnancies were then terminated. Of live-born infants with prenatally diagnosed CDH, 10 (33%) survived beyond 1 year of age. The gestational age at diagnosis did not affect the survival rate for live-born infants. Postnatal diagnosis occurred in 55 (47%) cases. Of these, 41 (74%) case subjects were born alive and diagnosed on clinical grounds after birth. In the remaining 14 cases, the diagnosis was made in postmortem examinations of fetuses from pregnancies that were terminated for other reasons (8 cases) or after spontaneous abortion or stillbirth (5 cases). Significant differences were found between prenatally and postnatally diagnosed live-born infants. Among liveborn infants, prenatal diagnosis was associated with a significantly reduced survival rate (33%, compared with 66% for postnatally diagnosed infants). Prenatally diagnosed live-born infants were of lower birth weight a...

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“…Owing in part to the heterogeneity in severity and possibly to differences in medical and surgical management, reported mortality rates of CDH vary widely among different centers, from 20% to 80% [3]: this creates important difficulties for the evaluation of new therapeutic approaches and the comparison of performances of different centers.…”

mentioning

confidence: 99%