Postnatal management and long‐term outcome for survivors with congenital diaphragmatic hernia

Chiu, Pao Chin; Hedrick, Holly L.

doi:10.1002/pd.2007

Cited by 98 publications

(69 citation statements)

References 127 publications

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“…Significant advances in the post-natal management of patients with CDH have resulted in improved survival rates over the past two decades [46]. Nevertheless, most series still reported overall post-natal survival in isolated CDH around 60-70%, although some survival rates of .90% have recently been reported [83,84].…”

Section: Long-term Prognosis Of Cdh Infancymentioning

confidence: 99%

“…These patients have a high incidence of respiratory, nutritional, musculoskeletal, neurological and gastrointestinal morbidities [46,[90][91][92]. Furthermore, the recent improved survival of very sick babies is associated with increased, particularly pulmonary, morbidity among survivors [2,46] persisting beyond the initial hospitalisation, especially in those treated with ECMO [93,94]. SPOEL et al [95] recently observed that mean maximal expiratory flows at functional residual capacity (FRC) were significantly lower than predicted values at 6 and 12 months of age in CDH survivors.…”

Section: Long-term Prognosis Of Cdh Infancymentioning

confidence: 99%

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Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

141

122

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Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.

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Section: Long-term Prognosis Of Cdh Infancymentioning

confidence: 99%

Section: Long-term Prognosis Of Cdh Infancymentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

141

122

View full text Add to dashboard Cite

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“…[5][6][7]13,19,20 These conditions may require frequent hospital and subspecialty care. 21,22 Trends in the incidence of and mortality from many specific conditions that would contribute to medical complexity (eg, CP, chronic lung disease, mental retardation, hydrocephalus, and congenital birth defects) show the occurrence of these individual conditions to be fairly stable over the recent past. [5][6][7]12,13,[23][24][25][26] On the other hand, some disorders have certainly increased in frequency.…”

mentioning

confidence: 99%

Increasing Prevalence of Medically Complex Children in US Hospitals

et al. 2010

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OBJECTIVE: In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period. PATIENTS AND METHODS: Data from the Nationwide Inpatient Sample, a component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined. RESULTS: Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100 000 (1991–1993) to 166 per 100 000 (2003–2005) (P[r] < .001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P = .002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100 000 (P < .001). CONCLUSIONS: Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years.

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“…In those who come to surgery the prognosis is generally good with at least 80% survival. 3,4,5 In general the surgery for bowel atresia is relatively straightforward with an anastomosis of proximal to distal bowel tailored depending on the size difference. Complications include delay in feeding with a dilated floppy proximal bowel segment, thus if possible the very dilated proximal segment in small bowel atresia should be excised or trimmed 6 .…”

Section: Congenital Diaphragmatic Herniamentioning

confidence: 99%