scholarly journals Is the Time Necessary to Obtain Preoperative Stabilization a Predictive Index of Outcome in Neonatal Congenital Diaphragmatic Hernia?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Andrea Gentili ◽  
Rosina De Rose ◽  
Elisa Iannella ◽  
Maria Letizia Bacchi Reggiani ◽  
Mario Lima ◽  
...  
Keyword(s):  
Intensive Care ◽  
Survival Rate ◽  
Tracheal Intubation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Postoperative Period ◽  
Clinical Pathway ◽  
Clinical Condition ◽  
Predictive Index ◽  
Care Path

Background. The study aims to verify if the time of preoperative stabilization (≤24 or >24 hours) could be predictive for the severity of clinical condition among patients affected by congenital diaphragmatic hernia.Methods. 55 of the 73 patients enrolled in the study achieved presurgical stabilization and underwent surgical correction. Respiratory and hemodynamic indexes, postnatal scores, the need for advanced respiratory support, the length of HFOV, tracheal intubation, PICU, and hospital stay were compared between patients reaching stabilization in ≤24 or >24 hours.Results. Both groups had a 100% survival rate. Neonates stabilized in ≤24 hours are more regular in the postoperative period and had an easier intensive care path; those taking >24 hours showed more complications and their care path was longer and more complex.Conclusions. The length of preoperative stabilization does not affect mortality, but is a valid parameter to identify difficulties in survivors’ clinical pathway.

Congenital diaphragmatic hernia: prenatal diagnosis permits immediate intensive care with high survival rate in isolated cases. A population-based study

2004 ◽  
Vol 24 (7) ◽  
pp. 487-493 ◽  
Author(s):  
Pierre Bétrémieux ◽  
Théophile Gaillot ◽  
Armelle de la Pintière ◽  
Alain Beuchée ◽  
Laurent Pasquier ◽  
...  
Keyword(s):  
Intensive Care ◽  
Prenatal Diagnosis ◽  
Survival Rate ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Population Based ◽  
High Survival ◽  
High Survival Rate ◽  
Population Based Study

scholarly journals Study on management of congenital diaphragmatic hernia

Mediscope ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 16-21
Author(s):  
MB Ali ◽  
AK Saha ◽  
SM Hossain ◽  
SFU Ahmed ◽  
AA Maruf
Keyword(s):  
Intensive Care ◽  
Survival Rate ◽  
Congenital Diaphragmatic Hernia ◽  
Endotracheal Tube ◽  
Diaphragmatic Hernia ◽  
Bowel Movement ◽  
Assisted Ventilation ◽  
Oral Feeding ◽  
Surgical Correction ◽  
Lung Expansion

Congenital diaphragmatic hernia (CDH) is a defect in the dome of diaphragm, more often in left and posterior-lateral that permits the herniation of abdominal contents into the thorax. Treatment requires stabilization prior to surgical correction. The best hospital series report 80-100% survival. The objective of the study was to present the experience regarding management of selected respiratory stable cases of CDH in non intensive care setup. Retrospective case series analysis was conducted on total 17 stable acyanotic patients with or without oxygen support and left sided defect were planned for surgical correction. Surgery was done per abdominally through left subcostal incision. In postoperative ward, patients received oxygen with nasal cannula and assisted ventilation with artificial manual breathing unit (AMBU) bag through ETT (endotracheal tube) if required. Patient’s vital parameters; pulse, respiration, oxygenation (SpO2) and hydration were monitored throughout postoperative period. Oral feeding was started after bowel movement on 2nd or 3rd postoperative day. Plain X-ray of the thorax and abdomen was repeated on 4th or 5th postoperative day to asses lung expansion. Postoperative follow up was given at one week and one month after discharge. The age of the patients ranged from 2 days to 2 year 6 months and the mean (SD) age and body weight was 1.2 (0.6) and 5.0 (1.2), respectively. The male/female and vaginal/cesarean delivery ratios were 12:5 and 10:7, respectively. Associated congenital anomalies found were 3 (17.7%): 1 (5.9%) cleft lip and palate, 1 (5.9%) undescended testes and 1 (5.9%) hypospadias. Respiratory distress was found in 15 (88.2%) patients and 2 (11.8%) patients with recurrent abdominal distension and vomiting. One baby needed assisted ventilation with endotracheal tube and AMBU bag for 24 hours postoperatively. One case with pneumothorax required chest drain for 5 days. All other patients had good lung expansion, correction of mediastinal shifting and no evidence of any pleural effusion. All babies tolerated feeding well postoperatively after bowel movement. Survival rate was 100%. The higher survival rate among the more mature babies suggests natural selection of those with minimal respiratory impairment. In our short series survival was 100% where surgical correction was made on selective 17 cases of left sided CDH in a non intensive care setup.Mediscope Vol. 3, No. 1: January 2016, Pages 16-21

Mothers of Infants With Congenital Diaphragmatic Hernia Describe “Breastfeeding” in the Neonatal Intensive Care Unit: “As Long as It’s My Milk, I’m Happy”

2017 ◽  
Vol 33 (3) ◽  
pp. 524-532 ◽  
Author(s):  
Elizabeth B. Froh ◽  
Janet A. Deatrick ◽  
Martha A. Q. Curley ◽  
Diane L. Spatz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Safety Net ◽  
Prospective Longitudinal

Background: Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births. Currently, there are no studies examining the health outcomes of infants with CDH and the effect of human milk. Research aim: This study aimed to describe the breastfeeding experience of mothers of infants with CDH cared for in the NICU. Methods: A prospective, longitudinal qualitative descriptive design was used. Phased interviews were conducted with a purposive sample of 11 CDH infant–mother dyads from a level 3 NICU in a children’s hospital. Results: Six themes emerged from the data: (a) hopeful for breastfeeding, (b) latching on . . . to the pump, (c) we’ve already worked so hard, (d) getting the hang of it—it’s getting easier, (e) a good safety net, and (f) finding a way that works for us. Conclusion: For this population of CDH infant–mother dyads, the term breastfeeding is not exclusive to direct feeding at the breast and the mothers emphasized the significance of providing their own mother’s milk through a combination of feeding mechanisms to their infants with CDH.

scholarly journals Survival Rate Changes in Neonates with Congenital Diaphragmatic Hernia and its Contributing Factors

2007 ◽  
Vol 22 (4) ◽  
pp. 687 ◽  
Author(s):  
Do-Hyun Kim ◽  
June Dong Park ◽  
Han-Suk Kim ◽  
So-Yeon Shim ◽  
Ee-Kyung Kim ◽  
...  
Keyword(s):  
Survival Rate ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Contributing Factors

scholarly journals PRENATAL DIAGNOSIS AND SURGICAL INNOVATIONS IN CONGENITAL DIAPHRAGMATIC HERNIA: EVALUATION OF PRE- AND POST-OPERATIVE MANAGEMENT

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
R. Angotti ◽  
F. Molinaro ◽  
K. Bici ◽  
E. Cerchia ◽  
M. Sica ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prenatal Diagnosis ◽  
Minimally Invasive ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Young Patients ◽  
Surgical Techniques ◽  
Female Ratio ◽  
Access Surgery

Introduction. Congenital diaphragmatic hernia (CDH) is still today considered a challenge from surgeons. Considerable progress in prenatal diagnosis, intensive care unit of neonates and surgical techniques, with the possibility to perform minimally access surgery, widely increased survival rates. The aim of this study is to analyze our series about long and short-term outcomes, also considering the progress made by minimally invasive techniques. Methods. The study was performed at Pediatric Surgery of Siena. It is a retrospective study that analyzed all patients with CDH (Bochdalek) treated in the last 14 years, from 2000 to 2013. Sex, side of the defect, presence of prenatal diagnosis, age of onset and symptoms, associate malformation, herniated organs, surgical technique and site of surgery, complications, recurrences, survival and followup were analyzed. Results. We included 23 patients. Five of them, were ruled out because of affected by diaphragmatic eventration or acquired diaphragmatic hernia. Forteen patients (77%) presented left CDH and 4 patients (23%) a right one. The male female ratio were 14:4. Prenatal diagnosis was performed in 5 patients (27,5%) at a mean gestational age of 29 weeks. Forteen patients (77%) had an early onset of symptoms (first day of life). Most common symptoms were respiratory distress and cyanosis; 4 patients (23%) had a late onset of symptoms, at a mean age of 9 months, and most common symptoms were failure to thrive and vomiting. Seven patients (39%) had associated malformation: common mesenterium (5 pts-71%). The colon was the most commonly herniated organ, present in 15 patients (83%), followed by small intestine in 13 patients (72%), stomach in 11 patients (61%), spleen in 9 patients (50%) and liver in 4 patients (23%). Seventeen patients (94,5%) underwent open surgery: 10 of them (59%) underwent a subcostal laparotomy approach, 7 of them (41%) underwent a supraumbelical laparotomy approach; 1 patient (5%) underwent minimally access surgery with thoracoscopy access. We performed performed surgery in the intensive care unit in 3 patients (16,5%). Six patients (33%) developed minor postoperatory complications. No patient had recurrence. Four patients died so we report a mortality rate of 23%. A follow-up investigation, with an average duration of 87 months, it is still going on in 5 patients (27,5%). Conclusions. The our survival rate was 77% and it reflects the encouraging reported data in the recent literature. These results are due to the reliability of the new resuscitation strategies, such as high-frequency oscillatory ventilation and the use of NO, the ability to perform surgery in the neonatal intensive care unit and, especially, to successfully perform minimally invasive surgery in newborn. The improvement of the survival showed the increasing of long-term morbidity end the requirement of a multidisciplinary followup. For these reasons, a multidisciplinary pathway for the management of young patients has been created, to follow them in a standardized way as early as the prenatal diagnosis.

scholarly journals Seasonality, Epidemiology and Outcome of Congenital Diaphragmatic Hernia in South West of Iran

2017 ◽  
Vol 6 (2) ◽  
pp. 28 ◽  
Author(s):  
Masoud Dehdashtian ◽  
Shiva Bashirnejad ◽  
Arash Malekian ◽  
Mohammad Reza Aramesh ◽  
Mohammad Hasan Aletayeb
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Seasonal Variation ◽  
Mortality Rate ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
South West ◽  
Very High

Introduction: The pathogenesis of congenital diaphragmatic hernia (CDH) is not clear. Risk factors including environmental factors have been implicated in the pathogenesis of few congenital anomalies. We aimed to assess the effect of season on the incidence of CDH and mortality rate in the southwest of Iran.Material and Methods: In this retrospective study, the records of 60 patients with CDH who were admitted at Neonatal Intensive Care Unit (NICU) of Imam Khomeini Hospital of Ahvaz, Iran were evaluated.Results: Assuming that all the neonates born with CDH in the region reach this hospital, overall CDH prevalence rate was 1.09 per 10 000 total births. Conceptions in spring and summer in this region had statistically significantly higher incidence of CDH. Survival rate in the series was 41.6%.Conclusion: Seasonal variation has impact on the incidence of CDH. Mortality rate in neonates with CDH is still very high.

Outcomes for Prenatally Diagnosed Right Congenital Diaphragmatic Hernia

2015 ◽  
Vol 47 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Corey W. Iqbal ◽  
S. Christopher Derderian ◽  
Leslie Lusk ◽  
Amaya Basta ◽  
Roy A. Filly ◽  
...  
Keyword(s):  
Survival Rate ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Retrospective Review ◽  
Prognostic Indicators ◽  
Tertiary Referral ◽  
Fetal Intervention ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Overall Mortality

Background: Right congenital diaphragmatic hernia (CDH) occurs less frequently than left CDH. Therefore, prognostic indicators for right CDH are not as well studied as for left CDH. Methods: A retrospective review from a single, tertiary referral center (from 1994 until July 2013) of patients with unilateral right CDH was conducted. Prenatal characteristics were evaluated and correlated with survival to discharge and need for extracorporeal membranous oxygen (ECMO). Results: In total, 34 patients were identified. There were 12 postnatal deaths and 2 fetal demises (6%), representing an overall mortality of 41%. Six patients required ECMO. Nine patients underwent fetal intervention and were analyzed separately. For patients not undergoing fetal intervention, the survival rate was 52% and a higher mean (±SD) lung-to-head ratio (LHR) was associated with survival (1.1 ± 0.4 vs. 0.8 ± 0.2, p = 0.03). There were no deaths or need for ECMO in any patient with an LHR ≥1.0. Of the 9 patients who underwent fetal intervention, survival was 78% and only 1 patient required ECMO. Fetal intervention was primarily tracheal occlusion (n = 8). Conclusions: An LHR <1.0 is associated with worse survival for right CDH and may also reflect the need for ECMO.

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