Abstract
Technically expedient repair of CDH defects is desirable. With increasing trend toward thoracoscopic repair, herein we examine physiologic predictors for the need for patch closure (PC) versus primary closure. All neonates who underwent surgical repair of CDH defects in a geographically defined region between 1992 and 2002 were included (n = 210). Two groups of patients were compared, primary repair (PR) versus PC. The 25th quartile was used as a cut off point for continuous variables. Univariate and multivariate logistic regression were performed. One hundred and fifty neonates underwent open PR (71.43%) versus 28.57% had PC. On univariate analyses the following variables were significantly associated with the need for PC: prenatal diagnosis, birth weight <2.7 kg, gestational age <37 weeks, APGAR at 5 min <6, immediate postnatal PCO2 >34, Immediate oxygen saturation <93%, use of Nitric oxide and the need for high frequency oscillation (HFO). On multivariate analyses, only a PCO2 >34 and the need for HFO were significantly associated with PC. Neonates with an initial PCO2 >34 or need HFO pre-operatively should be excluded from attempts to repair the CDH thoracoscopically based on their higher potential need for PC with its entailed technical difficulty and increased operative time
Similar content being viewed by others
References
Arca MJ, Barnhart DC, Lelli JL Jr et al (2003) Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 38:1563–1568
Yang EY, Allmendinger N, Johnson SM, Chen C, Wilson JM, Fishman SJ (2005) Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome. J Pediatr Surg 40(9):1369–1375
Azarow K, Messineo A, Pearl R, Filler R, Barker G, Bohn D (1997) Congenital diaphragmatic hernia–a tale of two cities: the Toronto experience. J Pediatr Surg 32(3):395–400
Wilson JM, Lund DP, Lillehei CW, Vacanti JP (1997) Congenital diaphragmatic hernia–a tale of two cities: the Boston experience. J Pediatr Surg 32(3):401–405
Moss RL, Chen CM, Harrison MR (2001) Prosthetic patch durability in congenital diaphragmatic hernia: a long-term follow-up study. J Pediatr Surg 36:152–154
Hajer GF, vd Staak FH, deHaan AF et al (1998) Recurrent diaphragmatic hernias: Which factors are involved? Eur J Pediatr Surg 8:329–333
Harting MT, Lally KP (2007) Surgical management of neonates with congenital diaphragmatic hernia. Semin Pediatr Surg 16(2):109–114
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zamakhshary, M., Mah, K., Mah, D. et al. Physiologic predictors for the need for patch closure in neonatal congenital diaphragmatic hernia. Pediatr Surg Int 24, 667–670 (2008). https://doi.org/10.1007/s00383-008-2152-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-008-2152-6