Abstract
A review of 100 consecutive cases of congenital diaphragmatic hernia (CDH) treated at our institute focusing on the efficacy of protocolized management (PM) was conducted. Of the 100 cases, 14 who became symptomatic more than 24 h after birth, and seven with fatal anomalies (four cardiac and three chromosomal) were excluded, leaving 79 subjects for this study. Of these, 41 were diagnosed prenatally (PD). Subjects were divided into four groups. Group I: No PD, no PM (n = 34), Group II: No PD, PM (n = 4), Group III: PD, no PM (n = 21), and Group IV: PD, PM (n = 20). PM includes criteria for planned delivery, use of high frequency oxygenation, nitric oxide, echocardiography (EC), and a medication schedule. Overall survival rates for Groups I, II, III, and IV were 73.5% (25/34), 75% (3/4), 38.1% (8/21), and 70.0% (14/20), respectively. Survival rates were higher when PM was used: 70.8% (Groups II, IV) versus 60.0% (Groups I, III). Survival rates were significantly lower if diagnosed prenatally (PD+): 53.7% (Groups III, IV) versus 73.7% (Groups I, II) (P < 0.01). However, in PD+ groups, survival was significantly higher if PM was used (P < 0.05). PM significantly reduced length of hospital stay (35.5 vs. 52.0 days: P < 0.05). EC was found to be a predictor for survival while post-ductal AaDO2 was not. In 17 cases with cardiac anomalies, PM did not affect survival. Our study suggests that use of PM for prenatally diagnosed CDH cases is associated with improved outcome, although the components of PM need to be tested in prospective trials to determine their true value.
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References
Joanne C, Carol B, Jan ED et al (2005) Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 116:356–363
Miyano T, Yanai T, Okawada M (2004) Fetoscopic surgery. Surg Ther 90:50–55
Wilson JM, Lund DP, Lillehei CW et al (1997) Congenital diaphragmatic hernia. A tale of two cities: the Boston experience. J Pediatr Surg 32:401–405
Azarow K, Messineo A, Pearl R et al (1997) Congenital diaphragmatic hernia. A tale of two cities: the Toronto experience. J Pediatr Surg 32:395–400
Reyes C, Chang LK, Waffarn F et al (1998) Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization. J Pediatr Surg 33:1010–1016
Clark RH, Hardin WD, Hirschl RB et al (1998) Current surgical management of congenital diaphragmatic hernia: a report from the congenital diaphragmatic hernia study group. J Pediatr Surg 33:1004–1009
Finer NN, Tierney A, Etches PC et al (1998) Congenital diaphragmatic hernia: developing a protocolized approach. J Pediatr Surg 33:1331–1337
Keshen TH, Gursoy M, Shew SB et al (1997) Does extracorporeal membrane oxygenation benefit neonates with congenital diaphragmatic hernia? Application of a predictive equation. J Pediatr Surg 32:818–822
Mishalany HG, Nakada K, Wooley MM (1979) Congenital diaphragmatic hernias: Eleven years’ experience. Arch Surg 114:118–123
Bloss RS, Turmen T, Beardmore HE et al (1980) Tolazoline therapy for persistent pulmonary hypertension after congenital diaphragmatic hernia repair. J Pediatr 97:984–988
Okazaki T, Kohno S, Hasegawa S et al (2003) Congenital diaphragmatic hernia: efficacy of ultrasound examination in its management. Pediatr Surg Int19:176–179
Boloker J, David A, Bateman et al (2002) Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg 37:357–366
Okuyama H, Kubota A, Oue T et al (2002) Inhaled nitric oxide with early surgery improves the outcome of antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 37:1188–1190
Cohen MS, Rychik J, Bush DM et al (2002) Influence of congenital heart disease on survival in children with congenital diaphragmatic hernia. J Pediatr 141:25–30
Haugen SE, Linker D, Eik-Nes S et al (1991) Congenital diaphragmatic hernia: determination of the optimal time for operation by echocardiographic monitering of the pulmonary artery pressure. J Pediatr Surg 26:560–562
Walsh-Sukys MC, Cornell DJ, Houston LN et al (1994) Treatment of persistent pulmonary hypertension of the newborn without hyperventilation: An assessment of diffusion of innovation. Pediatr 94:303–306
Bidani A, Tzouanakis AE, Cardenas VJ et al (1994) Permissive hypercapnia in acute respiratory failure. JAMA 272:957–962
Bailey PV, Connors RH, Tracy TF Jr et al (1989) A critical analysis of extracorporeal membrane oxygenation for congenital diaphragmatic hernia. Surgery 106:611–616
Harrison MR, Filly RA, Parer JT et al (1981) Management of the fetus with a urinary tract malformation. JAMA 246:635–639
Harrison MR, Adzick NS, Flake AW et al (1996) Correction of congenital diaphragmatic hernia in utero VIII: response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg 31:1339–1348
Harrison MR, Nyschaliska GB, Albanese CT, et al (1998) Correction of congenital diaphragmatic hernia in utero IX: Fetuses with poor prognosis (liver herniation and low lung to head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg 33:1017–1023
Mychakiska GB, Bealer JF, Graf JL et al (1997) Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg 32:227–230
Harrison MR, Keller RL, Hawgood SB et al (2003) A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Eng J Med 349:1916–1924
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Okawada, M., Okazaki, T., Yamataka, A. et al. Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases. Pediatr Surg Int 22, 925–930 (2006). https://doi.org/10.1007/s00383-006-1759-8
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DOI: https://doi.org/10.1007/s00383-006-1759-8