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Van der Veeken L, Vergote S, Kunpalin Y, Kristensen K, Deprest J, Bruschettini M. Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta-analysis. Prenat Diagn 2021; 42:318-329. [PMID: 33533064 DOI: 10.1002/pd.5916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) reportedly has neurologic consequences in childhood however little is known about the impact in isolated CDH. AIMS Herein we aimed to describe the risk of neurodevelopmental complications in children born with isolated CDH. MATERIALS & METHODS We systematically reviewed literature for reports on the neurological outcome of infants born with isolated CDH. The primary outcome was neurodevelopmental delay. Secondary outcomes included, motor skills, intelligence, vision, hearing, language and behavior abnormalities. RESULTS Thirteen out of 87 (15%) studies reported on isolated CDH, including 2624 out of 24,146 children. Neurodevelopmental delay was investigated in four studies and found to be present in 16% (3-34%) of children. This was mainly attributed to motor problems in 13% (2-30%), whereas cognitive dysfunction only in 5% (0-20%) and hearing in 3% (1-7%). One study assessed the effect of fetal surgery. When both isolated and non-isolated children were included, these numbers were higher. DISCUSSION This systematic review demonstrates that only a minority of studies focused on isolated CDH, with neurodevelopmental delay present in 16% of children born with CDH. CONCLUSION To accurately counsel patients, more research should focus on isolated CDH cases and examine children that underwent fetal surgery.
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Affiliation(s)
- Lennart Van der Veeken
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Simen Vergote
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Yada Kunpalin
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
| | - Karl Kristensen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
| | - Matteo Bruschettini
- Department of Pediatrics, Lund University, Skåne University Hospital, Lund, Sweden.,Cochrane Sweden, Skåne University Hospital, Lund, Sweden
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Rambaud J, Guilbert J, Guellec I, Jean S, Durandy A, Demoulin M, Amblard A, Carbajal R, Leger PL. [Extracorporeal membrane oxygenation in critically ill neonates and children]. Arch Pediatr 2017; 24:578-586. [PMID: 28416430 DOI: 10.1016/j.arcped.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/02/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
Extracorporeal membrane oxygenation is used as a last resort during neonatal and pediatric resuscitation in case of refractory circulatory or respiratory failure under maximum conventional therapies. Different types of ECMO can be used depending on the initial failure. The main indications for ECMO are refractory respiratory failure (acute respiratory distress syndrome, status asthmaticus, severe pneumonia, meconium aspiration syndrome, pulmonary hypertension) and refractory circulatory failure (cardiogenic shock, septic shock, refractory cardiac arrest). The main contraindications are a gestational age under 34 weeks or birth weight under 2kg, severe underlying pulmonary disease, severe immune deficiency, a neurodegenerative disease and hereditary disease of hemostasis. Neurological impairment can occur during ECMO (cranial hemorrhage, seizure or stroke). Nosocomial infections and acute kidney injury are also frequent complications of ECMO. The overall survival rate of ECMO is about 60 %. This survival rate can change depending on the initial disease: from 80 % for meconium aspiration syndrome to less than 10 % for out-of-hospital refractory cardiac arrest. Recently, mobile ECMO units have been created. These units are able to perform ECMO out of a referral center for untransportable critically ill patients.
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Affiliation(s)
- J Rambaud
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France.
| | - J Guilbert
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - I Guellec
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - S Jean
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Durandy
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - M Demoulin
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - A Amblard
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - R Carbajal
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P-L Leger
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Unité Inserm U1141, hôpital Robert-Debré, 75019 Paris, France
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Inamura N, Usui N, Okuyama H, Nagata K, Kanamori Y, Fujino Y, Takahashi S, Hayakawa M, Taguchi T. Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan. Pediatr Int 2015; 57:682-6. [PMID: 25488275 DOI: 10.1111/ped.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/01/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to clarify how extracorporeal membrane oxygenation (ECMO) is used to treat congenital diaphragmatic hernia (CDH) in Japan. METHODS We completed a nationwide survey of CDH involving 614 infants. The subjects included 43 patients who underwent ECMO. We compared the clinical data of the patients who did and did not survive ≥ 90 days, and analyzed the 24 h blood gas data in isolated CDH cases in both groups. RESULTS Of the 43 CDH patients, non-isolated CDH associated with other life-threatening or chromosomal anomalies was diagnosed in six patients. Only one of these six patients was able to discontinue ECMO and survived, and the other five died shortly after birth. The other 37 patients all had isolated CDH. The reason for initiating ECMO in 31 of these patients was persistent pulmonary hypertension of the newborn (PPHN). In the 37 patients with isolated CDH, ECMO was initiated within 24 h after birth. Sixteen patients (37%) survived ≥ 90 days, and intact discharge was possible in eight cases. Among the isolated CDH patients, on ROC analysis of the lowest oxygenation index (OI) to predict 90 day survival, the cut-off was 15. CONCLUSIONS ECMO is used to treat PPHN starting from an early period after birth, but the mortality and morbidity are not favorable. For lowest OI, the index used to predict survival following ECMO, the cut-off was 15.
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Affiliation(s)
- Noboru Inamura
- Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Kanamori
- Department of General Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Yuji Fujino
- Department of Intensive Care Unit, Osaka University Hospital, Osaka, Japan
| | - Shigehiro Takahashi
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Affiliation(s)
- Yves Durandy
- Intensive Care Unit and Perfusion Department; Pediatric Cardiac Surgery, Institut Hospitalier Jacques Cartier; Massy; France
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Léger PL, Guilbert J, Isambert S, Le Saché N, Hallalel F, Amblard A, Chevalier JY, Renolleau S. Pediatric Single-Lumen Cannula Venovenous Extracorporeal Membrane Oxygenation: A French Center Experience. Artif Organs 2013; 37:57-65. [DOI: 10.1111/aor.12024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Julia Guilbert
- Service de Réanimation Néonatale et Pédiatrique; Hôpital Armand-Trousseau; Paris; France
| | | | | | - Fazia Hallalel
- Service de Réanimation Néonatale et Pédiatrique; Hôpital Armand-Trousseau; Paris; France
| | - Alain Amblard
- Service de Réanimation Néonatale et Pédiatrique; Hôpital Armand-Trousseau; Paris; France
| | - Jean-Yves Chevalier
- Service de Réanimation Néonatale et Pédiatrique; Hôpital Armand-Trousseau; Paris; France
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Berthomieu L, Boumahni B, Jamal Bey K, Peslages P, Rayet I, Teyssier G. La coqueluche maligne : à propos de 3 observations. Arch Pediatr 2010; 17:144-8. [DOI: 10.1016/j.arcped.2009.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/30/2009] [Accepted: 10/25/2009] [Indexed: 11/30/2022]
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Waitzer E, Riley SP, Perreault T, Shevell MI. Neurologic outcome at school entry for newborns treated with extracorporeal membrane oxygenation for noncardiac indications. J Child Neurol 2009; 24:801-6. [PMID: 19196874 DOI: 10.1177/0883073808330765] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The neurologic outcomes at school age in children who underwent neonatal extracorporeal membrane oxygenation for noncardiac indications in a single institution surviving till the age of 5 years was determined by standardized neurologic assessment. Of 42 newborns undergoing extracorporeal membrane oxygenation, 24 underwent neurologic assessment by a single neurologist at 5 years of age. In all, 12 (50%) had a normal neurologic outcome. Lower gestational age and birth weight was found to be associated with an abnormal outcome as was septic shock as an indication for extracorporeal membrane oxygenation initiation. The number of peri-extracorporeal membrane oxygenation complications experienced by a child was associated with later epilepsy. Although invasive and implemented in critically ill infants, half of newborns undergoing extracorporeal membrane oxygenation will have a normal neurologic outcome at school age. Preexisting factors, rather than factors related to the extracorporeal membrane oxygenation itself, appear to be greater determinants of later neurologic outcomes.
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Affiliation(s)
- Elana Waitzer
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW To evaluate the impact of recent research on the management of congenital diaphragmatic hernia in the light of new theories on embryological development, earlier antenatal diagnosis, fetal and postnatal interventions together with advances in perinatal intensive care. RECENT FINDINGS The year 2007 provided in excess of 200 publications that address various aspects of congenital diaphragmatic hernia. The genetic basis and the causes of pulmonary hypoplasia at the molecular level are slowly being unravelled. Fetal MRI of lung volume, lung-head ratio, liver position and size of diaphragmatic defect have all been evaluated as early predictors of outcome and with a view to prenatal counselling. The impact of fetal interventions such as fetal endoluminal tracheal occlusion, the mode of delivery, the surgical techniques and agents for treating pulmonary hypertension were evaluated. The influence of associated anomalies and therapeutic interventions on the outcome and quality of life of survivors continue to be appraised. SUMMARY Deferred surgery after stabilization with gentle ventilation and reversal of pulmonary hypertension remain the cornerstones of management. Optimal presurgery and postsurgery ventilatory settings remain unproven. Continued improvement in neonatal intensive care raises the bar against which any intervention such as fetal endoluminal tracheal occlusion and extracorporeal membrane oxygenation will be judged.
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Baird R, MacNab YC, Skarsgard ED. Mortality prediction in congenital diaphragmatic hernia. J Pediatr Surg 2008; 43:783-7. [PMID: 18485938 DOI: 10.1016/j.jpedsurg.2007.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND A validated risk stratification tool for congenital diaphragmatic hernia (CDH) is required for accurate outcomes analyses. Existing mortality-predictive models include those of the CDH Study Group (CDHSG) based on birth weight and 5-minute Apgar score, the Canadian Neonatal Network (CNN) based on gestational age and admission score in Score for Neonatal Acute Physiology version II, and the Wilford Hall/Santa Rosa clinical prediction formula (WHSR(PF)) derived from blood gas measurements. The purpose of this study was to evaluate the calibration and discrimination of these predictive models using the Canadian Pediatric Surgical Network dataset. METHODS Neonatal risk variables and birth hospital survivorship were collected prospectively in 11 perinatal centers, between May 2005 and October 2006. Actual vs predicted outcomes were analyzed for each equation to measure the calibration and discrimination of each model. RESULTS Twenty (21.2%) of 94 infants with CDH died during birth hospitalization. The CDHSG model demonstrated superior discrimination (area under the receiver operator characteristic curve = 0.85; CNN = 0.79; WHSR(PF) = 0.63). Model calibration reflected by the Hosmer-Lemeshow P value was poorest with the WHSR(PF) = 0.37 and comparable between CDHSG and CNN (0.48 and 0.46, respectively). CONCLUSION Predictive outcome models are essential for risk-adjusted outcome analysis of CDH. The ideal predictive equation should prove robust across CDH datasets.
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Affiliation(s)
- Robert Baird
- Division of Pediatric Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada V6H 3V4
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