scholarly journals Differences in Outcomes in Prenatally Diagnosed Congenital Diaphragmatic Hernia Compared to Postnatal Detection: A Single-Center Experience

2015 ◽  
Vol 39 (4) ◽  
pp. 241-247 ◽  
Author(s):  
Carmen Mesas Burgos ◽  
Jenny Hammarqvist-Vejde ◽  
Björn Frenckner ◽  
Peter Conner
Keyword(s):  
Early Diagnosis ◽  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Retrospective Review ◽  
Survival Rates ◽  
Single Center ◽  
Severe Condition ◽  
Single Center Experience ◽  
Postnatal Diagnosis

Objectives: To compare outcomes in pregnancies with a prenatal detection of congenital diaphragmatic hernia (CDH) with children diagnosed after birth, treated at the same institution, and to determine the ability to predict prognosis through measurements of the observed to expected lung-to-head ratio (O/E LHR). Methods: This is a retrospective review of all children with CDH treated at our institution during 2006-2014. We compared outcomes of infants referred for surgery after postnatal diagnosis with outcomes of infants with prenatally diagnosed CDH. Results: In the prenatal group, O/E LHR was significantly different between survivors and deceased patients, with a cutoff at 35% O/E LHR. Survival to discharge and 1-year survival were significantly higher in the postnatal group that required intubation within 24 h; i.e., 92 and 89% versus 85 and 73% in the prenatal group (p < 0.05). There was less need for extracorporeal membrane oxygenation (ECMO), 41 versus 60%, and patch, 41 versus 75% (p < 0.001), in the postnatal group with early diagnosis compared with the prenatal group, respectively. Conclusion: Children with prenatally diagnosed CDH represent a population with a more severe condition compared to infants diagnosed after birth. They have poorer outcomes with higher needs for ECMO or use of patch, and lower survival rates were observed at an O/E LHR below 35%.

CONGENITAL DIAPHRAGMATIC HERNIA: SURVIVAL TREATED WITH VERY DELAYED SURGERY, SPONTANEOUS RESPIRATION, AND NO CHEST TUBE

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 810-810
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Retrospective Review ◽  
Chest Tube ◽  
Surgical Repair ◽  
Spontaneous Respiration ◽  
Respiratory Care ◽  
Delayed Surgery ◽  
Membrane Oxygenation

This report suggests that stabilization of the intrauterine to extrauterine transitional circulation, combined with a respiratory care strategy that avoids pulmonary overdistension, takes advantage of inherent biological cardiorespiratory mechanics, and very delayed surgery for congenital diaphragmatic hernia results in improved survival and decreases the need for extracorporeal membrane oxygenation (ECMO). This retrospective review of a 10-year experience in which the respiratory care strategy, ECMO availability, and technique of surgical repair remained essentially contant describes the evolution of this method of management of congenital diaphragmatic hernia.

scholarly journals Effect of Extracorporeal Membrane Oxygenation Availability on the Survival of Neonates with Congenital Diaphragmatic Hernia

2019 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Emel Okulu ◽  
Ufuk Ates ◽  
Ahmet Kahveci ◽  
Omer Erdeve ◽  
Begum Atasay ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Rescue Therapy ◽  
Survival Rates ◽  
Systolic Pressure ◽  
Oxygenation Index ◽  
Patient Characteristics ◽  
Membrane Oxygenation ◽  
Surgical Data

Objective: Neonatal congenital diaphragmatic hernia (CDH) is one of the major congenital anomalies with high mortality rates. Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for CDH patients who do not respond to conventional ventilation strategies. The aim of this study is to compare the epochs before and after the introduction of neonatal ECMO program and to determine its impact on response and survival of neonates with isolated CDH.Materials and Methods: Admitted neonates with CDH patients since 2012 were separated into two epochs according to the establishment of ECMO: Pre-ECMO period (January 2012–August 2015) and ECMO period (September 2015–December 2017). The demographic, clinical, and surgical data of the patients were compared between these two periods.Results: During the study period, a total of 35 neonates with CDH were admitted. Patient characteristics and surgical data were similar in both groups. Need for high-frequency oscillatory ventilation (HFOV) was higher in the pre-ECMO period (P = 0.04). The length of hospitalization was longer in ECMO period (P = 0.01). Three among seven patients who received ECMO survived (43%). Survival rates at the time of discharge were similar in groups (39% vs. 47%, P = 0.625). It was demonstrated that having oxygenation index >40 at first 24 h (odds ratio (OR): 12, 95% Cl 2.37–60.64, P = 0.03) and the ratio of pulmonary artery pressure to systolic pressure > 1 (OR: 6, 95% Cl 1.33–27.04, P = 0.02) increased mortality.Conclusion: The establishment of neonatal ECMO program was not associated with an improvement in survival of isolated CDH patients. We suggest that better outcomes may be achieved with defining selective criteria for ECMO candidates.

SNAPPE II Score As a Predictor of Survival in Neonates with Congenital Diaphragmatic Hernia: A Single Center Experience

2015 ◽  
Vol 26 (04) ◽  
pp. 316-321 ◽  
Author(s):  
Louisa Chiu ◽  
Jagdish Desai ◽  
Christina Shanti ◽  
Sharayu Rane ◽  
Prashant Agarwal ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Single Center ◽  
Single Center Experience

scholarly journals Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia: A Single Center Experience in Turkey

Acta Medica ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 1-7
Author(s):  
Ulas Kumbasar ◽  
Ahmet Aydin ◽  
Zeynelabidin Ozturk ◽  
Recep Oktay Peker ◽  
Saniye Ekinci ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Life Support ◽  
Limb Ischemia ◽  
Right Atrial ◽  
Diagnostic Laboratory ◽  
Membrane Oxygenation ◽  
Single Center Experience ◽  
Va Ecmo

Objective: Extracorporeal membrane oxygenation (ECMO) is a temporary life-support modality offered for stabilizing neonates with congenital diaphragmatic hernia (CDH) who are in a critical condition and unresponsive to optimal medical therapy. The aim of this study was to examine our institutional outcomes of early CDH repair on ECMO. Materials and Methods: A total of 17 ECMO-supported patients with CDH were evaluated and the demographic, diagnostic, laboratory, clinical data, complications and outcome of the patients were reported. Results: The study consisted of 7 females and 10 males. Mean birth weight (BW) was 3107 g (range, 2360–3840 g). Median age of ECMO initiation was 2.1 days. In total four patients received VV ECMO. Other patients received VA ECMO via aortic and right atrial cannulation. The mean duration of ECMO was 25 days (range: 1-140 days). Six patients (35.2%) could be weaned from ECMO. The most common ECMO related complications were hemorrhage, disseminated intravascular coagulation (DIC) and limb ischemia (64.7%, 41.1% and 29.4%, respectively). Diaphragmatic defect was repaired via a subcostal incision in 12 of 13 patients. In 88.2% of patients diaphragmatic repair was performed with polytetrafluoroethylene patch. In 77% of patients early CDH repair was performed concomitantly with ECMO insertion. The survival rate was 17.6%. Conclusion: Early repair of CDH in neonates on ECMO can be associated with high rates of morbidity and mortality. However, ECMO may be considered a life-saving measure for patients with CDH who would have otherwise not been salvageable.

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