The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in long-term morbidity?

Chiu, Pao Chin; Sauer, Carolien J.E.; Mihailovic, Alexandra; Adatia, Ian; Bohn, Desmond; Coates, Allan L.; Langer, Jacob C.

doi:10.1016/j.jpedsurg.2006.01.026

Cited by 128 publications

(92 citation statements)

References 22 publications

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“…Surgical complications are common among CDH survivors, but data are limited regarding long-term incidence patterns and associated risk factors [4,5,7,8,[12][13][14][15][16]. As with the adverse medical outcomes of neurodevelopmental delay, hearing loss, pulmonary insufficiency, and growth and nutritional failure, adverse surgical outcomes seem to be most frequent in those patients with a large CDH defect requiring patch repair.…”

Section: Discussionmentioning

confidence: 99%

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Jancelewicz

Keller

et al. 2010

Journal of Pediatric Surgery

124

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Section: Discussionmentioning

confidence: 99%

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Jancelewicz

Keller

et al. 2010

Journal of Pediatric Surgery

124

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“…[5][6][7][8][9][10][11][12][13] Surgical advances have resulted in an improved survival rate for infants with certain congenital defects including diaphragmatic hernia, abdominal wall defects, esophageal atresia, and cyanotic heart defects. [14][15][16][17][18] Many of these children have systemic health problems including neurodevelopmental disabilities, gastrointestinal illnesses, pulmonary complications, musculoskeletal abnormalities, and nutritional deficits. [5][6][7]13,19,20 These conditions may require frequent hospital and subspecialty care.…”

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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“…Mortality for live-born infants remains high (30-50%) in populationbased studies, despite treatment strategies focused on limitation of ventilator-and hyperoxia-induced lung injury (1)(2)(3). Chronic respiratory morbidity, growth failure, and neurodevelopmental delay are prevalent among survivors (7)(8)(9). Infants initially discharged requiring supplemental oxygen are at greatest risk for these morbidities (7,8).…”

mentioning

confidence: 99%

Congenital Diaphragmatic Hernia

Keller

Tacy²,

Hendricks‐Muñoz³

et al. 2010

Am J Respir Crit Care Med

140

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Rationale: Endothelin-1 (ET1) is dysregulated in pulmonary hypertension (PH). It may be important in the pathobiology of congenital diaphragmatic hernia (CDH). Objectives: We hypothesized that ET1 levels in the first month would be higher in infants with CDH who subsequently expired or were discharged on oxygen (poor outcome). We further hypothesized that ET1 levels would be associated with concurrent severity of PH. Methods: We sampled plasma at 24 to 48 hours, and 1, 2, and 4 weeks of age in 40 prospectively enrolled newborns with CDH. We performed echocardiograms to estimate pulmonary artery pressure at less than 48 hours of age and weekly to 4 weeks. PH was classified in relationship to systemic blood pressure (SBP): less than 2/3 SBP, 2/3 SBP-systemic is related to pressure, or systemic-to-suprasystemic pressure. Measurements and Main Results: ET1 levels at 1 and 2 weeks were higher in infants with poor outcome compared with infants discharged on room air (median and interquartile range: 27.2 [22.6, 33.7] vs. 19.1 [16.1, 29.5] pg/ml, P 5 0. 03; and 24.9 [17.6, 39.5] vs. 17.4 [13.7, 21.8] pg/ml, P 5 0.01 at 1 and 2 weeks, respectively). Severity of PH was significantly associated with increasing ET1 levels at 2 weeks (16.1 [13.7, 21.8], 21.0 [17.4, 31.1], and 23.6 [21.9, 39.5] pg/ml for increasing PH class, P 5 0.03). Increasing severity of PH was also associated with poor outcome at that time (P 5 0.001). Conclusions: Infants with CDH and poor outcome have higher plasma ET1 levels and severity of PH than infants discharged on room air. Severity of PH is associated with ET1 levels.

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The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in long-term morbidity?

Cited by 128 publications

References 22 publications

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Increasing Prevalence of Medically Complex Children in US Hospitals

Congenital Diaphragmatic Hernia

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