Trends in treatment and in-hospital mortality for neonates with congenital diaphragmatic hernia

Hagadorn, James I.; Brownell, Elizabeth; Herbst, Katherine W.; Trzaski, Jennifer; Neff, Stephen; Campbell, Brendan T.

doi:10.1038/jp.2015.46

Cited by 34 publications

(16 citation statements)

References 27 publications

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“…Despite the unclear etiology of CDH and management of PPHN, over the past few decades, reports have suggested increasing trends of survival in infants with CDH [76]. With the medical and surgical advances in the management of CDH, the reported overall survival is 70-90% [7, 76, 128].…”

Section: Resultsmentioning

confidence: 99%

“…With the medical and surgical advances in the management of CDH, the reported overall survival is 70-90% [7, 76, 128]. With ECMO, the survival is around 50% [112–114] with different centers reporting different criteria and outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Its use in preterm infant was also associated with lower survival rate [75]. However, this trial by its retrospective nature may be biased as sicker patients may have received surfactant Although there are no increasing trends in use of surfactant, it is still being used in preterm infants with CDH across centers [76]. Prospective trials are needed to evaluate the benefits of surfactant in infants with CDH.…”

Section: Reviewmentioning

confidence: 99%

“…Hypotension is a clinical concern and the infants should be monitored closely. Despite lack of evidence, the use of milrinone in the management of infants with CDH has increased [76]. A loading dose (50 μg/kg for 30–60 min) followed by a maintenance dose (0.33 μg/kg per minute and escalation to 0.66 and then to 1 μg/kg per minute based on response) are commonly used.…”

Section: Reviewmentioning

confidence: 99%

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Congenital Diaphragmatic hernia – a review

Chandrasekharan

Rawat

Madappa³

et al. 2017

matern health, neonatol and perinatol

220

151

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Congenital Diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. The defect may range from a small aperture in the posterior muscle rim to complete absence of diaphragm.The pathophysiology of CDH is a combination of lung hypoplasia and immaturity associated with persistent pulmonary hypertension of newborn (PPHN) and cardiac dysfunction. Prenatal assessment of lung to head ratio (LHR) and position of the liver by ultrasound are used to diagnose and predict outcomes. Delivery of infants with CDH is recommended close to term gestation. Immediate management at birth includes bowel decompression, avoidance of mask ventilation and endotracheal tube placement if required. The main focus of management includes gentle ventilation, hemodynamic monitoring and treatment of pulmonary hypertension followed by surgery. Although inhaled nitric oxide is not approved by FDA for the treatment of PPHN induced by CDH, it is commonly used.Extracorporeal membrane oxygenation (ECMO) is typically considered after failure of conventional medical management for infants ≥ 34 weeks’ gestation or with weight >2 kg with CDH and no associated major lethal anomalies. Multiple factors such as prematurity, associated abnormalities, severity of PPHN, type of repair and need for ECMO can affect the survival of an infant with CDH. With advances in the management of CDH, the overall survival has improved and has been reported to be 70-90% in non-ECMO infants and up to 50% in infants who undergo ECMO.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Congenital Diaphragmatic hernia – a review

Chandrasekharan

Rawat

Madappa³

et al. 2017

matern health, neonatol and perinatol

220

151

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“…Hagodorn ve ark. (23) , çoklu vazodilatör ajan kullanımı ile KDH olan olguların yaşamda kalma şansının arttığını göstermiştir. Çalışmamızda ise olguların %22'sinde pulmoner vazodilatör olarak nitrik oksit ve sildenafil kullanılmıştı.…”

Section: Gereç Ve Yöntemunclassified

Prognostic Factors in Bochdalek Hernia

Saraç¹,

Tartar²,

Bakal³

et al. 2019

Tcdd

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ÖZAmaç: Bu çalışmada, Bochdalek hernisi nedeniyle cerrahi uygulanan yenidoğanların mortalitesi üzerine etkili olan faktörlerin ortaya konulması amaçlanmıştır. Gereç ve Yöntem: 2001-2016 yılları arasında cerrahi tedavi uygulanan 36 Bochdalek hernili olgunun dosyaları geriye dönük olarak incelendi. Bulgular: Hastalardan ikisi ikiz, yaş, ortalama doğum ağırlığı 3000±503 g, ortanca cerrahi yaşı 4 (1-10) gün ve mekanik ventilatörde kalma süresi ise 8,5 (2-60) gündü. Serimizde mortalite oranı %25 idi. Gebelik yaşı ≤ 36 hafta olan hastalardaki mortalite oranı (%50) gebelik yaşı > 36 hafta olan hastalardaki mortalite oranından (%17,8) belirgin olarak daha yüksekti (p=0,046). Yenidoğan yoğun bakım ünitesinde izlenen olgulardaki mortalite oranı (%47,1) çocuk cerrahisi yoğun bakım ünitesinde izlenen olguların mortalite oranına (%5,2) göre anlamlı derecede daha yüksekti (p=0,005). Mortalite oranları sırasıyla prenatal tanı konulan olgularda %43, beşinci dk. Apgar skoru ≤5 olan olgularda %30, beşinci dk. Apgar skoru >5 olan olgularda %11 ve pulmoner hipertansiyonu olan olgularda ise %62,9'du. Sağ Bochdalek hernili hiçbir olgu kaybedilmemişti. Eksitus olan hastaların %77,7'sinde majör konjenital kardiyak anomaliler vardı. Eksitus olan olgularda pulmoner vazodilatör ajanların ve yüksek frekanslı mekanik ventilasyon modunun daha fazla kullanıldığı görüldü. Sonuç: Bochdalek hernili olgular %25 oranında mortaliteye sahiptirler. Pulmoner hipertansiyon, prematürite ve düşük doğum ağırlığı mortaliteyi etkileyen faktörlerdir. ABSTRACT Objective: In this study, it was aimed to investigate the factors affecting the mortality of newborn infants who underwent surgery due to Bochdalek hernia. Material and Methods: The files of 36 cases with Bochdalek hernia who underwent surgery between 2001 and 2016 were retrospectively reviewed. Results: Two of the patients were twins. The male to female ratio was 19/17. Median gestational age of the patients was 36 (32-38) weeks, maternal age 29 (16-41) years, mean birth weight 3000±503 g, median age at surgery 4 (1-10) days and duration of mechanical ventilation was 8.5 (2-60) days. The mortality rate in our series was 25%. The mortality rate (50%) in patients with gestational age ≤36 weeks was significantly higher than the mortality rate (17.8%) in patients with gestational age >36 weeks (p=0.046). The mortality rate (47.1%) of the patients followed up in the neonatal intensive care unit was significantly higher than the mortality rate (5.2% )those monitored in the intensive care unit of the pediatric surgery department (p=0.005). Mortality rates were 43% in cases with prenatal diagnosis, 30% in cases with 5th min. Apgar scores of ≤5 and 11% in cases with 5th min. Apgar scores of >5, and 62.9% in cases with pulmonary hypertension. None of the right Bochdalek hernia cases died. Major congenital cardiac anomalies were present in 77.7% of exited patients. Pulmonary vasodilator agents and high frequency mechanical ventilation mode were more commonly used in exited cases. Conclusion: The cases with Boch...

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