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Ding W, Gu Y, Wang H, Wu H, Zhang X, Zhang R, Wang H, Huang L, Lv J, Xia B, Zhong W, He Q, Hou L. Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia. Eur Radiol 2024; 34:1524-1533. [PMID: 37644150 DOI: 10.1007/s00330-023-10178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH. METHODS Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV). RESULTS MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781-1.000)), PH (0.828, 95%CI: (0.661-0.994)), and ECMO therapy (0.813, 95%CI: (0.645-0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR. CONCLUSIONS We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH. CLINICAL RELEVANCE STATEMENT Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH. KEY POINTS • We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility. • Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance. • Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.
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Affiliation(s)
- Wen Ding
- Department of Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuanyuan Gu
- Department of Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Haiyu Wang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Huiying Wu
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaochun Zhang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Rui Zhang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Hongying Wang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li Huang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Junjian Lv
- Surgical Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Bo Xia
- Surgical Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Zhong
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Qiuming He
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Longlong Hou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
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Rocha GMD. Congenital Hepatopulmonary Fusion. Eur J Pediatr Surg 2022; 32:477-496. [PMID: 36027900 DOI: 10.1055/s-0042-1749213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Congenital hepatopulmonary fusion (HPF) is a rare anomaly characterized by a fusion between the liver and lung parenchyma. HPF cases have been scarcely reported in the literature. An extensive search of publications was performed in the PubMed and Google Scholar databases without a time limit. In total, 34 clinical case reports were found in the literature, and a study by the Congenital Diaphragmatic Hernia (CDH) Study Group reported data on 10 patients with HPF. Of these 44 infants, 20 were male, 20 were female, and four were reported without gender specification. Nineteen (43.2%) patients required intubation on the first day of life. Six (13.6%) patients had their clinical presentation during the first year of life, and four (9%) clinically presented with HPF between 2.5 and 11 years of age. In these patients, cough, asthma-like symptoms, dyspnea, hemoptysis, right-side chest pain, respiratory infections, and pneumonia were the relevant clinical signs. Right-lung vascular anomalies were present in 18 (40.9%) patients. A complete liver and lung separation was successful in 17 (38.6%) patients. The overall survival was 56.8%. Congenital HPF has no gender predominance. In most cases, it behaves similar to a right CDH in need of resuscitation and intubation after birth. The majority of the cases are discovered during the surgical procedure for CDH. The best surgical approach has not been established and depends on the degree of fusion and vascular anomalies. An advanced imaging assessment is necessary before a surgical approach is attempted. The prognosis is ominous.
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Affiliation(s)
- Gustavo M D Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Masahata K, Yamoto M, Umeda S, Nagata K, Terui K, Fujii M, Shiraishi M, Hayakawa M, Amari S, Masumoto K, Okazaki T, Inamura N, Toyoshima K, Koike Y, Furukawa T, Yazaki Y, Yokoi A, Endo M, Tazuke Y, Okuyama H, Usui N. Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38:1745-1757. [PMID: 36102982 DOI: 10.1007/s00383-022-05232-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). METHODS A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. RESULTS A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. CONCLUSIONS This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.
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Affiliation(s)
- Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Satoshi Umeda
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Fujii
- Department of Health Science, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Shoichiro Amari
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Noboru Inamura
- Department of Pediatrics, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Katsuaki Toyoshima
- Departments of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Taizo Furukawa
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Yazaki
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akiko Yokoi
- Departments of Pediatric Surgery, Kobe Children's Medical Center, Kobe, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
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Image-based prenatal predictors of postnatal survival, extracorporeal life support, and defect size in right congenital diaphragmatic hernia. J Perinatol 2022; 42:1202-1209. [PMID: 35922665 DOI: 10.1038/s41372-022-01470-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/13/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the association between prenatal ultrasound (US) and magnetic resonance imaging (MRI) characteristics in right congenital diaphragmatic hernia (RCDH) with postnatal outcome. STUDY DESIGN CDH Study Group data were reviewed for all RCDH infants (n = 156) born between 2015 and 2019. Prenatal US and MRI lung size measurements were correlated with survival, extracorporeal life support (ECLS), and defect size. RESULT Overall survival was 64.1%. ECLS was required in 40.4%. US and MRI-based prenatal assessment of pulmonary hypoplasia does not predict survival. Prenatal measurement of lung size using either US or MRI correlates with ECLS use. Only MRI-based measures of lung size are associated with defect size. CONCLUSION Image-based prenatal predictors of survival, ECLS, and defect size are of limited value in RCDH. Extrapolation of prenatal survival and morbidity indicators from left to right-sided CDH is not appropriate. There is an urgent need to develop RCDH prenatal prediction models.
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Gaiduchevici AE, Cîrstoveanu CG, Socea B, Bizubac AM, Herișeanu CM, Filip C, Mihălțan FD, Dimitriu M, Jacotă-Alexe F, Ceaușu M, Spătaru RI. Neonatal intensive care unit on-site surgery for congenital diaphragmatic hernia. Exp Ther Med 2022; 23:436. [PMID: 35607371 PMCID: PMC9121203 DOI: 10.3892/etm.2022.11363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of 'Maria S. Curie' Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.
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Affiliation(s)
- Alina Elena Gaiduchevici
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Cătălin Gabriel Cîrstoveanu
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
- Discipline of Pediatrics, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, ‘Sf. Pantelimon’ Emergency Clinical Hospital, 021659 Bucharest, Romania
- Discipline of Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ana Michaela Bizubac
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Carmen Mariana Herișeanu
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Cristina Filip
- Department of Cardiology, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Florin Dumitru Mihălțan
- Department of Pneumology, ‘Marius Nasta’ National Institute of Pneumology, 050159 Bucharest, Romania
- Discipline of Pneumology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, ‘Sf. Pantelimon’ Emergency Hospital, 021659 Bucharest, Romania
- Discipline of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florentina Jacotă-Alexe
- Department of Obstetrics and Gynecology, ‘Sf. Pantelimon’ Emergency Hospital, 021659 Bucharest, Romania
| | - Mihail Ceaușu
- Department of Histopathology, ‘Alexandru Trestioreanu’ National Institute of Oncology, 022328 Bucharest, Romania
- Discipline of Histopathology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu-Iulian Spătaru
- Department of Pediatric Surgery, ‘Maria S. Curie’ Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
- Discipline of Pediatric Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Boehm AK, Hillebrandt KH, Dziodzio T, Krenzien F, Neudecker J, Spuler S, Pratschke J, Sauer IM, Andreas MN. Tissue engineering for the diaphragm and its various therapeutic possibilities – A Systematic Review. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Agnes K Boehm
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
| | - Karl H Hillebrandt
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charitéplatz 1 Berlin 10117 Germany
| | - Tomasz Dziodzio
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charitéplatz 1 Berlin 10117 Germany
| | - Felix Krenzien
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charitéplatz 1 Berlin 10117 Germany
| | - Jens Neudecker
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
| | - Simone Spuler
- Muscle Research Unit Experimental and Clinical Research Center Charité Universitätsmedizin Berlin and Max‐Delbrück‐Centrum für Molekulare Medizin in der Helmholtz‐Gemeinschaft Lindenberger Weg 80 Berlin 13125 Germany
| | - Johann Pratschke
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Cluster of Excellence Matters of Activity. Image Space Material funded by the Deutsche Forschungsgemeinschaft (DFG German Research Foundation) under Germany's Excellence Strategy Berlin EXC 2025 Germany
| | - Igor M Sauer
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Cluster of Excellence Matters of Activity. Image Space Material funded by the Deutsche Forschungsgemeinschaft (DFG German Research Foundation) under Germany's Excellence Strategy Berlin EXC 2025 Germany
| | - Marco N Andreas
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
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Tamura R, O'Connor E, Jaffray B. Surgeon level variation in outcome of repair of congenital diaphragmatic hernia with particular reference to the management of recurrence. J Pediatr Surg 2021; 56:2207-2214. [PMID: 33775404 DOI: 10.1016/j.jpedsurg.2021.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study is to investigate firstly, the rate of recurrence following primary repair of a congenital diaphragmatic hernia (CDH) and secondly, the rate of recurrence following revisional surgical repair. The primary outcome is rate of recurrence. Secondary outcomes are to establish whether recurrence is related to surgeon, surgeon volume, side of defect, the use of a patch, or a thoracopscopic approach METHODS: All repairs performed in an English regional center over 22 years were recorded. Possible explanatory variables were whether the repair was itself of a recurrence, the surgeon's identity, the surgeon's volume of prior repairs, the side of the defect, the use of a patch. RESULTS 198 repairs were performed; 170 primary repairs and 28 of recurrences. Failure occurred significantly more commonly among recurrences (32%) than primary repairs (11%), p = 0.005. Failure of the primary repair was significantly more common where a patch was used 8/34 (23%) rather than a sutured repair 10/136 (7%), p = 0.006, or where a thoracoscopic technique was used 4/13 (31%) rather than laparotomy 14/157 (9%) p = 0.01. Failure of the primary repair was unrelated to the identity of the surgeon (Χ2 = 5, p = 0.9) or the volume of prior repairs (t = 0.3, p = 0.6). However, failure of repair of a recurrence was significantly related to the surgeon's volume of prior repairs (t = 2.3, p = 0.01) and the identity of the surgeon (Χ2 = 17, p = 0.014), but not the use of a patch (Χ2 = 1.6, p = 0.2). CONCLUSIONS Repair of a recurrence of a CDH has a higher probability of failure than the original repair and is related to both the identity of the surgeon and the prior volume of experience. There is a volume outcome relationship for the repair of recurrence, but not the primary repair of CDH. Our study suggests the repair of recurrence of CDH should be restricted to surgeons with proven outcomes for this procedure.
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Affiliation(s)
- Ryo Tamura
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Elizabeth O'Connor
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Bruce Jaffray
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK.
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Jeong J, Lee BS, Cha T, Jung E, Kim EAR, Kim KS, Kim DY, Namgoong JM, Kim SC, Lee MY, Won HS. Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center's experience. BMC Pediatr 2021; 21:460. [PMID: 34666738 PMCID: PMC8526355 DOI: 10.1186/s12887-021-02931-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. METHODS We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. RESULTS A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. CONCLUSIONS The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.
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Affiliation(s)
- Jiyoon Jeong
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Byong Sop Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Teahyen Cha
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Euiseok Jung
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ki-Soo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dae Yeon Kim
- Department of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Jung-Man Namgoong
- Department of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Seong Chul Kim
- Department of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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van Oudtshoorn S, Gikenye N, Kikiros C, Gera P. Muddle in the middle: A rare case of a hepatopulmonary fusion and lung sequestration in a neonate with a right-sided congenital diaphragmatic hernia. J Paediatr Child Health 2021; 57:1692-1694. [PMID: 33428283 DOI: 10.1111/jpc.15342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah van Oudtshoorn
- Paediatric Surgery Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Njeri Gikenye
- Paediatric Surgery Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Colin Kikiros
- Paediatric Surgery Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Parshotam Gera
- Paediatric Surgery Department, Perth Children's Hospital, Perth, Western Australia, Australia
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Risk factors for mortality in infants with congenital diaphragmatic hernia: a single center experience. Wien Klin Wochenschr 2021; 133:674-679. [PMID: 33783619 PMCID: PMC8008339 DOI: 10.1007/s00508-021-01843-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/27/2021] [Indexed: 11/14/2022]
Abstract
Background Despite current progress in research of congenital diaphragmatic hernia, its management remains challenging, requiring an interdisciplinary team for optimal treatment. Objective Aim of the present study was to evaluate potential risk factors for mortality of infants with congenital diaphragmatic hernia. Methods A single-center chart review of all patients treated with congenital diaphragmatic hernia over a period of 16 years, at the Medical University of Vienna, was performed. A comparison of medical parameters between survivors and non-survivors, as well as to published literature was conducted. Results During the observational period 66 patients were diagnosed with congenital diaphragmatic hernia. Overall survival was 84.6%. Left-sided hernia occurred in 51 patients (78.5%) with a mortality of 7.8%. In comparison, right-sided hernia occurred less frequently (n = 12) but showed a higher mortality (33.3%, p = 0.000). Critically instable patients were provided with venoarterial extracorporeal membrane oxygenation (ECMO, 32.3%, n = 21). Survival rate among these patients was 66.7%. Right-sided hernia, treatment with inhaled nitric oxide (iNO) over 15 days and the use of ECMO over 10 days were significant risk factors for mortality. Conclusion The survival rate in this cohort is comparable to the current literature. Parameters such as the side of the diaphragmatic defect, duration of ECMO and inhaled nitric oxide were assessed as mortality risk factors. This analysis of patients with congenital diaphragmatic hernia enhances understanding of risk factors for mortality, helping to improve management and enabling further evaluation in prospective clinical trials.
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11
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Russo FM, Cordier AG, Basurto D, Salazar L, Litwinska E, Gomez O, Debeer A, Nevoux J, Patel S, Lewi L, Pertierra A, Aertsen M, Gratacos E, Nicolaides KH, Benachi A, Deprest J. Fetal endoscopic tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia: European multicenter experience. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:378-385. [PMID: 32924187 DOI: 10.1002/uog.23115] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the neonatal outcome of fetuses with isolated right-sided congenital diaphragmatic hernia (iRCDH) based on prenatal severity indicators and antenatal management. METHODS This was a retrospective review of prospectively collected data on consecutive cases diagnosed with iRCDH before 30 weeks' gestation in four fetal therapy centers, between January 2008 and December 2018. Data on prenatal severity assessment, antenatal management and perinatal outcome were retrieved. Univariate and multivariate logistic regression analysis were used to identify predictors of survival at discharge and early neonatal morbidity. RESULTS Of 265 patients assessed during the study period, we excluded 40 (15%) who underwent termination of pregnancy, two cases of unexplained fetal death, two that were lost to follow-up, one for which antenatal assessment of lung hypoplasia was not available and six cases which were found to have major associated anomalies or syndromes after birth. Of the 214 fetuses with iRCDH included in the neonatal outcome analysis, 86 were managed expectantly during pregnancy and 128 underwent fetal endoscopic tracheal occlusion (FETO) with a balloon. In the expectant-management group, lung size measured by ultrasound or by magnetic resonance imaging was the only independent predictor of survival (observed-to-expected lung-to-head ratio (o/e-LHR) odds ratio (OR), 1.06 (95% CI, 1.02-1.11); P = 0.003). Until now, stratification for severe lung hypoplasia has been based on an o/e-LHR cut-off of 45%. In cases managed expectantly, the survival rate was 15% (4/27) in those with o/e-LHR ≤ 45% and 61% (36/59) for o/e-LHR > 45% (P = 0.001). However, the best o/e-LHR cut-off for the prediction of survival at discharge was 50%, with a sensitivity of 78% and specificity of 72%. In the expectantly managed group, survivors with severe pulmonary hypoplasia stayed longer in the neonatal intensive care unit than did those with mildly hypoplastic lungs. In fetuses with an o/e-LHR ≤ 45% treated with FETO, survival rate was higher than in those with similar lung size managed expectantly (49/120 (41%) vs 4/27 (15%); P = 0.014), despite higher prematurity rates (gestational age at birth: 34.4 ± 2.7 weeks vs 36.8 ± 3.0 weeks; P < 0.0001). In fetuses treated with FETO, gestational age at birth was the only predictor of survival (OR, 1.25 (95% CI, 1.04-1.50); P = 0.02). CONCLUSIONS Antenatal measurement of lung size can predict survival in iRCDH. In fetuses with severe lung hypoplasia, FETO was associated with a significant increase in survival without an associated increase in neonatal morbidity. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F M Russo
- Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - A-G Cordier
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Centre for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
| | - D Basurto
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - L Salazar
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Barcelona, Spain
| | - E Litwinska
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - O Gomez
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Barcelona, Spain
| | - A Debeer
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
| | - J Nevoux
- ENT Department, AP-HP, Bicêtre Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - S Patel
- Department of Paediatric Surgery, Kings' College Hospital, London, UK
| | - L Lewi
- Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - A Pertierra
- Clinical Department of Neonatology, Sant Joan de Déu University Hospital, Barcelona, Spain
| | - M Aertsen
- Clinical Department of Radiology, Unit Pediatric Radiology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Imaging and Pathology, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - E Gratacos
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Barcelona, Spain
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Benachi
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Centre for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
| | - J Deprest
- Clinical Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
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12
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Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany. CHILDREN-BASEL 2021; 8:children8020160. [PMID: 33672568 PMCID: PMC7924040 DOI: 10.3390/children8020160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 01/13/2023]
Abstract
Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail.
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13
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Zahn KB, Schaible T, Rafat N, Weis M, Weiss C, Wessel L. Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia-A Large Prospective, Observational Cohort Study at One Referral Center. Front Pediatr 2021; 9:796478. [PMID: 34976900 PMCID: PMC8719630 DOI: 10.3389/fped.2021.796478] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: After neonatal repair of congenital diaphragmatic hernia (CDH) recurrence is the most severe surgical complication and reported in up to 50% after patch implantation. Previous studies are difficult to compare due to differences in surgical techniques and retrospective study design and lack of standardized follow-up or radiologic imaging. The aim was to reliably detect complication rates by radiologic screening during longitudinal follow-up after neonatal open repair of CDH and to determine possible risk factors. Methods: At our referral center with standardized treatment algorithm and follow-up program, consecutive neonates were screened for recurrence by radiologic imaging at defined intervals during a 12-year period. Results: 326 neonates with open CDH repair completed follow-up of a minimum of 2 years. 68 patients (21%) received a primary repair, 251 (77%) a broad cone-shaped patch, and 7 a flat patch (2%). Recurrence occurred in 3 patients (0.7%) until discharge and diaphragmatic complications in 28 (8.6%) thereafter. Overall, 38 recurrences and/or secondary hiatal hernias were diagnosed (9% after primary repair, 12.7% after cone-shaped patch; p = 0.53). Diaphragmatic complications were significantly associated with initial defect size (r = 0.26). In multivariate analysis left-sided CDH, an abdominal wall patch and age below 4 years were identified as independent risk factors. Accordingly, relative risks (RRs) were significantly increased [left-sided CDH: 8.5 (p = 0.03); abdominal wall patch: 3.2 (p < 0.001); age ≤4 years: 6.5 (p < 0.002)]. 97% of patients with diaphragmatic complications showed no or nonspecific symptoms and 45% occurred beyond 1 year of age. Conclusions: The long-term complication rate after CDH repair highly depends on surgical technique: a comparatively low recurrence rate seems to be achievable in large defects by implantation of a broad cone-shaped, non-absorbable patch. Longitudinal follow-up with regular radiologic imaging until adolescence is essential to reliably detecting recurrence to prevent acute incarceration and chronic gastrointestinal morbidity with their impact on prognosis. Based on our findings and literature review, a risk-stratified approach to diaphragmatic complications is proposed.
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Affiliation(s)
- Katrin B Zahn
- Department of Pediatric Surgery, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany.,ERNICA-Center, Mannheim, Germany
| | - Thomas Schaible
- ERNICA-Center, Mannheim, Germany.,Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Neysan Rafat
- Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Meike Weis
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucas Wessel
- Department of Pediatric Surgery, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany.,ERNICA-Center, Mannheim, Germany
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14
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Pinton A, Boubnova J, Becmeur F, Kuhn P, Senat MV, Stirnemann J, Capelle M, Rosenblatt J, Massardier J, Vaast P, Le Bouar G, Desrumaux A, Connant L, Begue L, Parmentier B, Perrotin F, Diguet A, Benoist G, Muszynski C, Scalabre A, Winer N, Michel JL, Casagrandre-Magne F, Jouannic JM, Gallot D, Coste Mazeau P, Sapin E, Maatouk A, Saliou AH, Sentilhes L, Biquard F, Mottet N, Favre R, Benachi A, Sananès N. Is laterality of congenital diaphragmatic hernia a reliable prognostic factor? French national cohort study. Prenat Diagn 2020; 40:949-957. [PMID: 32279384 DOI: 10.1002/pd.5706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/07/2019] [Accepted: 03/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival. METHODS This was a cohort study using the French national database of the Reference Center for Diaphragmatic Hernias. The principal endpoint was survival after hospitalization in intensive care. We made a comparative study between right CDH and left CDH by univariate and multivariate analysis. Terminations and stillbirths were excluded from analyses of neonatal outcomes. RESULTS A total of 506 CDH were included with 67 (13%) right CDH and 439 left CDH (87%). Rate of survival was 49% for right CDH and 74% for left CDH (P < .01). Multivariate analysis showed two factors significantly associated with mortality: thoracic herniation of liver (OR 2.27; IC 95% [1.07-4.76]; P = .03) and lung-to-head-ratio over under expected (OR 2.99; IC 95% [1.41-6.36]; P < .01). Side of CDH was not significantly associated with mortality (OR 1.87; IC 95% [0.61-5.51], P = .26). CONCLUSION Rate of right CDH mortality is more important than left CDH. Nevertheless after adjusting for lung-to-head-ratio and thoracic herniation of liver, right CDH does not have a higher risk of mortality than left CDH.
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Affiliation(s)
- Anne Pinton
- Department of Obstetrics and Gynecology, Hôpital Trousseau, AP-HP, Paris, France.,Sorbonne Université, boulevard de l'Hôpital, Paris, France
| | - Julia Boubnova
- Department of Obstetrics and Gynecology, Maternité de la Conception, Gynepole, Marseille, France
| | - François Becmeur
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Kuhn
- Department of Neonatal Intensive Care Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, Strasbourg, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Julien Stirnemann
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Necker-Enfants malades, AP-HP, Paris, France.,EHU7328, Université de Paris and Institut IMAGINE, Paris, France
| | - Marianne Capelle
- Department of Obstetrics and Gynecology, Maternité de la Conception, Gynepole, Marseille, France
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Universitaire Robert-Debré, AP-HP, Paris, France
| | - Jérôme Massardier
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Claude Bernard, Lyon, France
| | - Pascal Vaast
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Gwenaelle Le Bouar
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Rennes, University of Rennes 1, Rennes, France
| | - Amélie Desrumaux
- Department of Pediatrics, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Laure Connant
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Laetitia Begue
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Benoit Parmentier
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Tours, François Rabelais University, Tours, France
| | - Alain Diguet
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Guillaume Benoist
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Caen, Normandie University, Caen, France
| | - Charles Muszynski
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | - Aurélien Scalabre
- Department of Pediatric Surgery, Centre Hospitalo-Universitaire de Saint Etienne, Saint-Etienne, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Nantes, Nantes, France.,NUN, INRAE, UMR 1280, PhAN, Université de Nantes, CIC Femme enfant adolescent, Nantes, France
| | - Jean-Luc Michel
- Department of Pediatric Surgery, Centre Hospitalo-Universitaire de Félix Guyon, Bellepierre Saint-Denis, Saint-Denis, France
| | | | - Jean-Marie Jouannic
- Department of Obstetrics and Gynecology, Fetal Medicine Department, Hôpital Trousseau AP-HP, Paris, France.,Sorbonne université, boulevard de l'Hôpital, Paris, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire Estaing, Pole FEE, Clermont-Ferrand, France
| | - Perrine Coste Mazeau
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Limoges, Limoges, France
| | - Emmanuel Sapin
- Department of Pediatric Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon, France
| | - Alexis Maatouk
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Nancy, Nancy, France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Brest, Hôpital Morvan, Brest, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Florence Biquard
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Besançon, Université de Franche-Comté, Besançon, France
| | - Romain Favre
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology and Reproductive Medicine, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Nicolas Sananès
- Department of Obstetrics and Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,INSERM UMR-S 1121 "Biomatériaux et bioingénierie", Université de Strasbourg, Strasbourg, France
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15
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Larsen UL, Jepsen S, Strøm T, Qvist N, Toft P. Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark. BMC Pediatr 2020; 20:196. [PMID: 32381070 PMCID: PMC7204041 DOI: 10.1186/s12887-020-02072-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Between 1998 and 2015, we report on the survival of congenital diaphragmatic hernia (CDH)-infants presenting with symptoms within the first 24 h of life, treated at Odense University Hospital (OUH), a tertiary referral non-extracorporeal membrane oxygenation (ECMO) hospital for paediatric surgery. Methods We performed a retrospective cohort study of prospectively identified CDH-infants at our centre. Data from medical records and critical information systems were obtained. Baseline data included mode of delivery and infant condition. Outcome data included 24-h, 28-day, and 1 year mortality rates and management data included intensive care treatment, length of stay in the intensive care unit, time of discharge from hospital, and surgical intervention. Descriptive analyses were performed for all variables. Survivors and non-survivors were compared for baseline and treatment data. Results Ninety-five infants were identified (44% female). Of these, 77% were left-sided hernias, 52% were diagnosed prenatally, and 6.4% had concurrent malformations. The 28-day mortality rate was 21.1%, and the 1 year mortality rate was 22.1%. Of the 21 non-survivors, nine died within the first 24 h, and 10 were sufficiently stabilised to undergo surgery. A statistically significant difference was observed between survivors and non-survivors regarding APGAR score at 1 and 5 min., prenatal diagnosis, body length at birth, and delivery at OUH. Conclusions Our outcome results were comparable to published data from other centres, including centres using ECMO.
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Affiliation(s)
- Ulla Lei Larsen
- Research Unit for Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Søren Jepsen
- Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark
| | - Thomas Strøm
- Research Unit for Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark: University of Southern Denmark, Odense, Denmark
| | - Palle Toft
- Research Unit for Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
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16
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Abramov A, Fan W, Hernan R, Zenilman AL, Wynn J, Aspelund G, Khlevner J, Krishnan U, Lim FY, Mychaliska GB, Warner BW, Cusick R, Crombleholme T, Chung D, Danko ME, Wagner AJ, Azarow K, Schindel D, Potoka D, Soffer S, Fisher J, McCulley D, Farkouh-Karoleski C, Chung WK, Duron V. Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis. J Pediatr Surg 2020; 55:33-38. [PMID: 31677822 DOI: 10.1016/j.jpedsurg.2019.09.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500-3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH). METHODS We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH. RESULTS A total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p=0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p=0.022) and a higher frequency of need for oxygen at discharge (p=0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence. CONCLUSION In this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair. TYPE OF STUDY Prognosis study LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Alexey Abramov
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Weijia Fan
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rebecca Hernan
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Ariela L Zenilman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Wynn
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Gudrun Aspelund
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie Khlevner
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Usha Krishnan
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Foong-Yen Lim
- Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - George B Mychaliska
- Section of Pediatric Surgery, Fetal Diagnosis and Treatment Center, University of Michigan Health System, Ann Arbor, MI, USA
| | - Brad W Warner
- Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Cusick
- Division of Pediatric Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Timothy Crombleholme
- Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dai Chung
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Melissa E Danko
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Amy J Wagner
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kenneth Azarow
- Pediatric Surgery Division, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - David Schindel
- Division of Pediatric Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Douglas Potoka
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Sam Soffer
- Department of Pediatric Surgery, Northwell Health, New York, NY, USA
| | - Jason Fisher
- Division of Pediatric Surgery, New York University Langone Medical Center, New York, NY, USA
| | - David McCulley
- Department of Pediatrics, Meriter-Unity Point Health, Madison, WI, USA
| | | | - Wendy K Chung
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Department of Medicine, Columbia University Medical Center, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Vincent Duron
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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17
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Style CC, Olutoye OO, Belfort MA, Ayres NA, Cruz SM, Lau PE, Shamshirsaz AA, Lee TC, Olutoye OA, Fernandes CJ, Cortes MS, Keswani SG, Espinoza J. Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:752-758. [PMID: 30640410 DOI: 10.1002/uog.20216] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/19/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Fetal endoscopic tracheal occlusion (FETO) is associated with increased perinatal survival and reduced need for extracorporeal membrane oxygenation (ECMO) in fetuses with severe congenital diaphragmatic hernia (CDH). This study evaluates the impact of FETO on the resolution of pulmonary hypertension (PH) in fetuses with isolated CDH. METHODS We reviewed retrospectively the medical records of all fetuses evaluated for CDH between January 2004 and July 2017 at a single institution. Fetuses with additional major structural or chromosomal abnormalities were excluded. CDH cases were classified retrospectively into mild, moderate and severe groups based on prenatal magnetic resonance imaging indices (observed-to-expected total fetal lung volume and percentage of intrathoracic liver herniation). Presence of PH was determined based on postnatal echocardiograms. Logistic regression analyses were performed to evaluate the relationship between FETO and resolution of PH by 1 year of age while controlling for side of the CDH, use of ECMO, gestational age at diagnosis, gestational age at delivery, fetal gender, sildenafil use at discharge and CDH severity. Resolution of PH by 1 year of age was compared between a cohort of fetuses with severe CDH that underwent FETO and a cohort that did not have the procedure (non-FETO). A subanalysis was performed restricting the analysis to isolated left CDH. Parametric and non-parametric tests were used for comparisons. RESULTS Of 257 CDH cases evaluated, 72% (n = 184) had no major structural or chromosomal anomalies of which 58% (n = 107) met the study inclusion criteria. The FETO cohort consisted of 19 CDH cases and the non-FETO cohort (n = 88) consisted of 31 (35%) mild, 32 (36%) moderate and 25 (28%) severe CDH cases. All infants with severe CDH, regardless of whether they underwent FETO, had evidence of neonatal PH. FETO (OR, 3.57; 95% CI, 1.05-12.10; P = 0.041) and ECMO (OR, 5.01; 95% CI, 2.10-11.96; P < 0.001) were independent predictors of resolution of PH by 1 year of age. A higher proportion of infants with severe CDH that underwent FETO had resolution of PH by 1 year after birth compared with infants with severe CDH in the non-FETO cohort (69% (11/16) vs 28% (7/25); P = 0.017). Similar results were observed when the analysis was restricted to cases with left-sided CDH (PH resolution in 69% (11/16) vs 28% (5/18); P = 0.032). CONCLUSION In infants with severe CDH, FETO and ECMO are independently associated with increased resolution of PH by 1 year of age. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C C Style
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - N A Ayres
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Cardiology Section, Baylor College of Medicine, Houston, TX, USA
| | - S M Cruz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - P E Lau
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - T C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - O A Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - C J Fernandes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Newborn Section, Baylor College of Medicine, Houston, TX, USA
| | - M Sanz Cortes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - S G Keswani
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
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18
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Ali K, Dassios T, Khaliq SA, Williams EE, Tamura K, Davenport M, Greenough A. Outcomes of infants with congenital diaphragmatic hernia by side of defect in the FETO era. Pediatr Surg Int 2019; 35:743-747. [PMID: 31089883 DOI: 10.1007/s00383-019-04484-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the outcomes of infants with a right (RCDH) versus a left-sided (LCDH) congenital diaphragmatic hernia (CDH) and whether these differed according to whether the infants had undergone fetoscopic tracheal occlusion (FETO). METHODS Demographics, the type of surgical repair, preoperative and postoperative courses and respiratory, gastrointestinal, surgical and skeletal morbidities at follow-up were compared between infants with a RCDH or LCDH. A sub-analysis was undertaken in those who had undergone FETO. RESULTS During the study period, there were 167 infants with a LCDH and 24 with a RCDH; 106 underwent FETO (15 RCDH). Overall, the need for inhaled nitric oxide (p = 0.036) was higher in the RCDH group and, at follow-up, infants with RCDH were more likely to have a hernia recurrence (p = 0.043), pectus deformity (p = 0.019), scoliosis (p = 0.029) and suffer chronic respiratory morbidity (p = 0.001). There were, however, no significant differences in short term or long term outcomes (hernia recurrence (p = 0.237), pectus deformity (p = 0.322), scoliosis (p = 0.0174) or chronic respiratory morbidity (p = 0.326)) between infants with a right or left sided CDH who had undergone FETO. CONCLUSION Overall, infants with a RCDH compared to those with a LCDH had greater long-term morbidity, but not if they had undergone FETO.
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Affiliation(s)
- Kamal Ali
- Neonatal Intensive Care Centre, 4th Floor Golden Jubilee Wing, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Theodore Dassios
- Neonatal Intensive Care Centre, 4th Floor Golden Jubilee Wing, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.,Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Syed Abdul Khaliq
- Neonatal Intensive Care Centre, 4th Floor Golden Jubilee Wing, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Emma E Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kentaro Tamura
- Neonatal Intensive Care Centre, 4th Floor Golden Jubilee Wing, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.,Division of Neonatology, Maternal and Perinatal Centre, Toyama University Hospital, Toyama, Japan
| | - Mark Davenport
- Department of Paediatric Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Neonatal Intensive Care Centre, 4th Floor Golden Jubilee Wing, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK. .,Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,The Asthma UK Centre for Allergic Mechanisms of Asthma, King's College London, London, UK. .,NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK.
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19
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Sefton EM, Gallardo M, Kardon G. Developmental origin and morphogenesis of the diaphragm, an essential mammalian muscle. Dev Biol 2018; 440:64-73. [PMID: 29679560 DOI: 10.1016/j.ydbio.2018.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/14/2018] [Accepted: 04/14/2018] [Indexed: 11/17/2022]
Abstract
The diaphragm is a mammalian skeletal muscle essential for respiration and for separating the thoracic and abdominal cavities. Development of the diaphragm requires the coordinated development of muscle, muscle connective tissue, tendon, nerves, and vasculature that derive from different embryonic sources. However, defects in diaphragm development are common and the cause of an often deadly birth defect, Congenital Diaphragmatic Hernia (CDH). Here we comprehensively describe the normal developmental origin and complex spatial-temporal relationship between the different developing tissues to form a functional diaphragm using a developmental series of mouse embryos genetically and immunofluorescently labeled and analyzed in whole mount. We find that the earliest developmental events are the emigration of muscle progenitors from cervical somites followed by the projection of phrenic nerve axons from the cervical neural tube. Muscle progenitors and phrenic nerve target the pleuroperitoneal folds (PPFs), transient pyramidal-shaped structures that form between the thoracic and abdominal cavities. Subsequently, the PPFs expand across the surface of the liver to give rise to the muscle connective tissue and central tendon, and the leading edge of their expansion precedes muscle morphogenesis, formation of the vascular network, and outgrowth and branching of the phrenic nerve. Thus development and morphogenesis of the PPFs is critical for diaphragm formation. In addition, our data indicate that the earliest events in diaphragm development are critical for the etiology of CDH and instrumental to the evolution of the diaphragm. CDH initiates prior to E12.5 in mouse and suggests that defects in the early PPF formation or their ability to recruit muscle are an important source of CDH. Also, the recruitment of muscle progenitors from cervical somites to the nascent PPFs is uniquely mammalian and a key developmental innovation essential for the evolution of the muscularized diaphragm.
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Affiliation(s)
- Elizabeth M Sefton
- Department of Human Genetics University of Utah, Salt Lake City, UT 84112, USA
| | - Mirialys Gallardo
- Department of Human Genetics University of Utah, Salt Lake City, UT 84112, USA
| | - Gabrielle Kardon
- Department of Human Genetics University of Utah, Salt Lake City, UT 84112, USA
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20
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Jain V, Yadav DK, Kandasamy D, Gupta DK. Hepatopulmonary fusion: a rare and potentially lethal association with right congenital diaphragmatic hernia. BMJ Case Rep 2017; 2017:bcr-2016-218227. [PMID: 28196822 DOI: 10.1136/bcr-2016-218227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hepatopulmonary fusion is an extremely rare accompaniment of right congenital diaphragmatic hernia. It is associated with abnormal systemic arterial supply and venous drainage of the right lung along with congenital heart disease. Children with this condition have a comparatively poor prognosis. We report a case of right congenital diaphragmatic hernia with hepatopulmonary fusion along with review of the literature with stress on diagnosis and management.
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Affiliation(s)
- Vishesh Jain
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Devendra Kumar Gupta
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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21
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Abstract
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options. Nevertheless, short and long-term complications following neonatal surgery continue to have profound and sometimes lasting effects on individual patients, families, and society.
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Affiliation(s)
- Mauricio A Escobar
- Pediatric Surgery, Mary Bridge Children׳s Hospital, PO Box 5299, MS: 311-W3-SUR, 311 South, Tacoma, Washington 98415-0299.
| | - Michael G Caty
- Section of Pediatric Surgery, Department of Surgery, Yale-New Haven Children׳s Hospital, New Haven, Connecticut
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22
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Snoek KG, Reiss IKM, Tibboel J, van Rosmalen J, Capolupo I, van Heijst A, Schaible T, Post M, Tibboel D. Sphingolipids in Congenital Diaphragmatic Hernia; Results from an International Multicenter Study. PLoS One 2016; 11:e0155136. [PMID: 27159222 PMCID: PMC4861280 DOI: 10.1371/journal.pone.0155136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia is a severe congenital anomaly with significant mortality and morbidity, for instance chronic lung disease. Sphingolipids have shown to be involved in lung injury, but their role in the pathophysiology of chronic lung disease has not been explored. We hypothesized that sphingolipid profiles in tracheal aspirates could play a role in predicting the mortality/ development of chronic lung disease in congenital diaphragmatic hernia patients. Furthermore, we hypothesized that sphingolipid profiles differ between ventilation modes; conventional mechanical ventilation versus high-frequency oscillation. METHODS Sphingolipid levels in tracheal aspirates were determined at days 1, 3, 7 and 14 in 72 neonates with congenital diaphragmatic hernia, born after > 34 weeks gestation at four high-volume congenital diaphragmatic hernia centers. Data were collected within a multicenter trial of initial ventilation strategy (NTR 1310). RESULTS 36 patients (50.0%) died or developed chronic lung disease, 34 patients (47.2%) by stratification were initially ventilated by conventional mechanical ventilation and 38 patients (52.8%) by high-frequency oscillation. Multivariable logistic regression analysis with correction for side of the defect, liver position and observed-to-expected lung-to-head ratio, showed that none of the changes in sphingolipid levels were significantly associated with mortality /development of chronic lung disease. At day 14, long-chain ceramides 18:1 and 24:0 were significantly elevated in patients initially ventilated by conventional mechanical ventilation compared to high-frequency oscillation. CONCLUSIONS We could not detect significant differences in temporal sphingolipid levels in congenital diaphragmatic hernia infants with mortality/development of chronic lung disease versus survivors without development of CLD. Elevated levels of ceramides 18:1 and 24:0 in the conventional mechanical ventilation group when compared to high-frequency oscillation could probably be explained by high peak inspiratory pressures and remodeling of the alveolar membrane.
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Affiliation(s)
- Kitty G. Snoek
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center- Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
| | - Irwin K. M. Reiss
- Department of Neonatology, Erasmus Medical Center- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jeroen Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irma Capolupo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas Schaible
- Department of Neonatology, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Martin Post
- Program of Physiology and Experimental Medicine, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center- Sophia Children’s Hospital, Rotterdam, The Netherlands
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23
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Right- versus left-sided congenital diaphragmatic hernia: a comparative outcomes analysis. J Pediatr Surg 2016; 51:900-2. [PMID: 27342009 DOI: 10.1016/j.jpedsurg.2016.02.049] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Right-sided congenital diaphragmatic hernia (R-CDH) occurs in up to 25% of all CDH cases, but has been less widely studied compared to left-sided defects. We sought to compare characteristics and outcomes of left- versus right-sided defects in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution. METHODS We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2002 through December 2014. Categorical variables were analyzed by Fisher's exact test and continuous variables by Mann-Whitney t-test (p≤0.05). RESULTS A total of 330 CDH patients were treated more than the 12-year study period, with 274 (83%) left-sided and 56 (17%) right-sided cases identified. Specific pulmonary morbidities were associated with R-CDH, with increased duration of nitric oxide therapy, increased requirement for tracheostomy, increased requirement for supplemental oxygen at the time of NICU discharge, and increased chronic pulmonary hypertension with requirement for long-term Sildenafil therapy. CONCLUSIONS In this series, R-CDH was not associated with increased mortality, but was associated with increased requirement for pulmonary vasodilatory therapy and requirement for tracheostomy. The high incidence of pulmonary complications indicates increased severity of pulmonary hypoplasia in R-CDH, supporting a role for delivery in tertiary centers with expertise in CDH management.
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