Right congenital diaphragmatic hernia: an 18-year experience

Midrio, Paola; Gobbi, Dalia; Baldo, Vincenzo; Gamba, Piergiorgio

doi:10.1016/j.jpedsurg.2006.10.044

Cited by 33 publications

(18 citation statements)

References 21 publications

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“…Recently, the Congenital Diaphragmatic Hernia Study Group reported an overall survival rate of 64% based on data from institutions in North America, Europe, and Australia [5,7,11,12]. Thus, the overall survival rate of at our institution (a 9 years study) is nearly similar to those reported from other institutions regardless the applied resources, however, the survival rate at our institution has not been constant over this period.…”

Section: Discussionsupporting

confidence: 67%

“…This ratio may also depend on the gestational age at measurement and may be less reliable in mid-gestation. Recently, the ratio is being a part or used as a prenatal predictor of outcome; a measurement below 25% was reported to be associated with a less than 20% chance of survival [12]. We agreed that routine prenatal ultrasonography was not performed on all pregnant mothers, in some instance the rate of outborn delivery without a prenatal diagnosis was very high at our state this may form a limitation in our study.…”

Section: Discussionmentioning

confidence: 76%

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The Role of Predictors Parameters in the Management Policy and Outcome of Congenital Diaphragmatic Hernia with the Lack of Resources in Single Pediatric Surgery Unit

Aboud¹

2017

IJBECS

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Abstract:Background: The objective of this study is to have the interest to know how far the present study underscores the improved survival rate for patients with CDH and risk factors affecting the outcome with the lack of many essential facilities. Our inquiries: shall we proceed without ECMO and related resources! Patients and Methods: The records of patients admitted with CDH to the pediatric surgery unit at the Maternity and Children Teaching Hospital Al Qadisiya, Iraq, from January 1, 2005, to the end of December 2014 were retrospectively reviewed. Reports obtained about operative findings, respiratory complications, although attempts were made to confirm a suspected diagnosis of pulmonary hypertension using echocardiography. Despite that, the permissive hypercapnia and ECMO were not practiced during the study period (these facilities still unavailable in our unit), we considering that the studied patients suspected to have such facilities according to ECMO protocol. All presentation factors with some of the predictive parameters are studied and taken as background to analyze our study. Statistical analyses performed using the Statistical Package for Social Sciences (SPSS) version 20 software and Excel 2016. Independent t-test used for analysis of normally distributed continuous data. A p-value of <.0001 considered statistically significant. Results: Thirty-one patients (26 neonates) were managed at our unit with an overall survival 19 of the total patients 73.07% and 14 (53.84%) of the neonates. Male presented 18 (69.23%) out of the total. Birth weight in grams (range) 3100 (2100 to 4390). Apgar (mean) at 5 min. after delivery (range) 6.2±2.1. At the level of Prenatal factors, chest to head circumference ratio <0.80 presented as the most important risk factor (Odd ratio 27.50, 95% confidence intervals (CI) upper 289.13 and p-value <.0001). At birth factors, associated major anomalies (Odd ratio 3.50, 95% CI upper 17.89 and p-value <.0001) formed risk parameter. Overall, both favorable and unfavorable factors had significant correlation and predictive effects on both survival and mortality groups respectively. Conclusion: A composite of prognostic and predictive parameters, however, organize our workup and can magnify our management future policy despite that, these prognostic indicators measure different aspects of CDH.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 76%

The Role of Predictors Parameters in the Management Policy and Outcome of Congenital Diaphragmatic Hernia with the Lack of Resources in Single Pediatric Surgery Unit

Aboud¹

2017

IJBECS

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“…Yonekura and colleagues [11] reported intermittent obstruction of the IVC by a right-sided anterior CDH that precipitated a case of Budd-Chiari syndrome in a neonate. Malformations of the right bronchial tree in R-CDH can lead to bronchobiliary fistula [12] as well as pneumoperitoneum because of an open-ended bronchus terminating between the pleura and liver capsule [7]. In addition, multiple cases of hepatopulmonary fusion, a rare and almost uniformly fatal abnormality where the hypoplastic right lung is anatomically inseparable from the adjacent liver parenchyma, have been reported [7,[13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Malformations of the right bronchial tree in R-CDH can lead to bronchobiliary fistula [12] as well as pneumoperitoneum because of an open-ended bronchus terminating between the pleura and liver capsule [7]. In addition, multiple cases of hepatopulmonary fusion, a rare and almost uniformly fatal abnormality where the hypoplastic right lung is anatomically inseparable from the adjacent liver parenchyma, have been reported [7,[13][14][15]. Abnormalities of the suprahepatic IVC and hepatic veins may develop secondary to an R-CDH, occasionally leading to direct hepatic vein insertion into the RA [16].…”

Section: Discussionmentioning

confidence: 99%

“…Although large studies focusing on outcome in R-CDH are lacking, survival data from smaller case series report a 15% to 44% lower survival rate among infants with right-vs left-sided defects [3][4][5][6][7][8]. Given this discrepancy, it is helpful to identify any barriers to successful ECMO cannulation in cases of R-CDH, so as to minimize any additional morbidity in a population already at increased risk.…”

mentioning

confidence: 99%

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Challenges to cannulation for extracorporeal support in neonates with right-sided congenital diaphragmatic hernia

Fisher¹,

Jefferson²,

Kuenzler

et al. 2007

Journal of Pediatric Surgery

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

Chiu¹,

Hedrick²

2008

Prenatal Diagnosis

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Significant advances in the postnatal management of patients with congenital diaphragmatic hernia (CDH) have resulted in a remarkable improvement in survival rates over the past two decades. The success of current postnatal management of CDH patients has rendered fetal intervention to be limited to the most severe cases, and the role for prenatal treatment of CDH patients remains unclear. The adoption of lung-preserving strategies including high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) have improved CDH outcomes especially in those patients with significant ventilatory or circulatory compromise. Survival rates of up to 90% are being reported in some high-volume centers. However, the increased survival in CDH patients has been accompanied by an increase in neurological, nutritional and musculoskeletal morbidity among the long-term survivors. This has resulted in the need to provide resources for the long-term follow-up and support of this patient population. In this article, the postnatal management strategies and primary and secondary outcomes of high-volume international pediatric surgical centers will be reviewed. Finally, the role of a multidisciplinary management team for the follow-up of long-term CDH survivors will be discussed.

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Right congenital diaphragmatic hernia: an 18-year experience

Cited by 33 publications

References 21 publications

The Role of Predictors Parameters in the Management Policy and Outcome of Congenital Diaphragmatic Hernia with the Lack of Resources in Single Pediatric Surgery Unit

The Role of Predictors Parameters in the Management Policy and Outcome of Congenital Diaphragmatic Hernia with the Lack of Resources in Single Pediatric Surgery Unit

Challenges to cannulation for extracorporeal support in neonates with right-sided congenital diaphragmatic hernia

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

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