1
|
King S, Carr BDE, Mychaliska GB, Church JT. Surgical approaches to congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151441. [PMID: 38986242 DOI: 10.1016/j.sempedsurg.2024.151441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Surgical repair of the diaphragm is essential for survival in congenital diaphragmatic hernia (CDH). There are many considerations surrounding the operation - why the operation matters, optimal timing of repair and its relation to extracorporeal life support (ECLS) use, minimally invasive versus open approaches, and strategies for reconstruction. Surgery is both affected by, and affects, the physiology of these infants and is an important factor in determining long-term outcomes. Here we discuss the evidence and provide insight surrounding this complex decision making, technical pearls, and outcomes in repair of CDH.
Collapse
Affiliation(s)
- Sarah King
- C.S. Mott Children's Hospital, Section of Pediatric Surgery, Department of Surgery, University of Michigan. Ann Arbor, MI, USA
| | - Benjamin D E Carr
- Doernbecher Children's Hospital, Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University. Portland, OR, USA
| | - George B Mychaliska
- C.S. Mott Children's Hospital, Section of Pediatric Surgery, Department of Surgery, University of Michigan. Ann Arbor, MI, USA
| | - Joseph T Church
- C.S. Mott Children's Hospital, Section of Pediatric Surgery, Department of Surgery, University of Michigan. Ann Arbor, MI, USA.
| |
Collapse
|
2
|
Pollack JC, Hollinger LE, Buchmiller TL, Jancelewicz T. Long-term follow-up in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151443. [PMID: 38972214 DOI: 10.1016/j.sempedsurg.2024.151443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
With improvements in initial care for patients with congenital diaphragmatic hernia (CDH), the number of CDH patients with severe disease who are surviving to discharge has increased. This growing population of patients faces a unique set of long-term challenges, multisystem adverse outcomes, and post-intervention complications requiring specialized multidisciplinary follow-up. Early identification and intervention are essential to mitigate the potential morbidity associated with these challenges. This manuscript outlines a general framework for long-term follow-up for the CDH patient, including cardiopulmonary, gastrointestinal, neurodevelopmental, surgical, and quality of life outcomes.
Collapse
Affiliation(s)
- Jessica C Pollack
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, USA; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - Laura E Hollinger
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, USA
| | | | - Tim Jancelewicz
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, USA.
| |
Collapse
|
3
|
Pulvirenti R, IJsselstjin H, Mur S, Morini F. Approaches to nutrition and feeding in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151442. [PMID: 39004036 DOI: 10.1016/j.sempedsurg.2024.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In patients with congenital diaphragmatic hernia1, nutrition can represent a challenge both in the short and long term. Its failure to resolve can have a significant impact on multiple aspects of the lives of patients with congenital diaphragmatic hernia (CDH), ranging from lung function to neurodevelopment. In this review, we will describe the causes of nutritional problems in patients with CDH, their consequences, and possible strategies to address them.
Collapse
Affiliation(s)
- Rebecca Pulvirenti
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands; Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Hanneke IJsselstjin
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sebastien Mur
- Department of Neonatology, Lille University Hospital, French CDH reference center, Lille, France
| | - Francesco Morini
- Department of Maternal, Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
4
|
Sloan P, Johng S, Daniel JM, Rhee CJ, Mahmood B, Gravari E, Marshall S, Downey AG, Braski K, Gowda SH, Fernandes CJ, Dariya V, Haberman BE, Seabrook R, Makkar A, Gray BW, Cookson MW, Najaf T, Rintoul N, Hedrick HL, DiGeronimo R, Weems MF, Ades A, Chapman R, Grover TR, Keene S. A clinical consensus guideline for nutrition in infants with congenital diaphragmatic hernia from birth through discharge. J Perinatol 2024; 44:694-701. [PMID: 38627594 DOI: 10.1038/s41372-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To develop a consensus guideline to meet nutritional challenges faced by infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN The CDH Focus Group utilized a modified Delphi method to develop these clinical consensus guidelines (CCG). Topic leaders drafted recommendations after literature review and group discussion. Each recommendation was sent to focus group members via a REDCap survey tool, and members scored on a Likert scale of 0-100. A score of > 85 with no more than 25% outliers was designated a priori as demonstrating consensus among the group. RESULTS In the first survey 24/25 recommendations received a median score > 90 and after discussion and second round of surveys all 25 recommendations received a median score of 100. CONCLUSIONS We present a consensus evidence-based framework for managing parenteral and enteral nutrition, somatic growth, gastroesophageal reflux disease, chylothorax, and long-term follow-up of infants with CDH.
Collapse
Affiliation(s)
- Patrick Sloan
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110-1093, USA.
| | - Sandy Johng
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - John M Daniel
- Department of Pediatrics, Division of Neonatology, University of Missouri Kansas School of Medicine, Kansas City, MO, USA
| | - Christopher J Rhee
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Burhan Mahmood
- Department of Pediatrics, Division of Newborn Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Evangelia Gravari
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Ann G Downey
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Katie Braski
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sharada H Gowda
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Vedanta Dariya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Beth E Haberman
- Department of Pediatrics, Division of Neonatology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ruth Seabrook
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Abhishek Makkar
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian W Gray
- Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Michael W Cookson
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Tasnim Najaf
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO, 63110-1093, USA
| | - Natalie Rintoul
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Holly L Hedrick
- Department of Pediatric General Thoracic and Fetal Surgery Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert DiGeronimo
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Mark F Weems
- Division of Neonatology and Le Bonheur Children's Hospital, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anne Ades
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Chapman
- Department of Pediatrics, USC Keck School of Medicine, Fetal & Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Theresa R Grover
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah Keene
- Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
5
|
Bourezma M, Mur S, Storme L, Cailliau E, Vaast P, Sfeir R, Lauriot Dit Prevost A, Aubry E, Le Duc K, Sharma D. Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia. J Clin Med 2023; 12:jcm12062415. [PMID: 36983415 PMCID: PMC10059888 DOI: 10.3390/jcm12062415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral feeding autonomy in patients treated for CDH. METHODS This monocentric cohort study included 138 patients with CDH. Eighty-four patients were analyzed after the exclusion of 54 patients (11 with delayed postnatal diagnosis, 5 with chromosomal anomaly, 9 with genetic syndrom, 13 with right-sided CDH, and 16 who died before discharge and before oral feeding autonomy was acquired). They were divided into two groups: oral feeding autonomy at initial hospital discharge (group 1, n = 51) and nutritional support at discharge (group 2, n = 33). Antenatal, postnatal, and perisurgical data were analyzed from birth until first hospital discharge. To remove biased or redundant factors related to CDH severity, statistical analysis was adjusted according to the need for a patch repair. RESULTS After analysis and adjustment, delayed oral feeding autonomy was not related to observed/expected lung-to-head ratio (LHR o/e), intrathoracic liver and/or stomach position, or operative duration. After adjustment, prophylactic gastrostomy (OR adjusted: 16.3, IC 95%: 3.6-74.4) and surgical reoperation (OR adjusted: 5.1, IC 95% 1.1-23.7) remained significantly associated with delayed oral feeding autonomy. CONCLUSIONS Delayed oral feeding autonomy occurred in more than one third of patients with CDH. Both prophylactic gastrostomy and surgical reoperation represent significant risk factors. Bowel obstruction might also impact oral feeding autonomy. Prophylactic gastrostomy seems to be a false "good idea" to prevent failure to thrive. This procedure should be indicated case per case. Bowel obstruction and all surgical reoperations represent decisive events that could impact oral feeding autonomy.
Collapse
Affiliation(s)
- Mélina Bourezma
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Sébastien Mur
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Laurent Storme
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Emeline Cailliau
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
- Biostatistics Department, CHU Lille, FR-59000 Lille, France
| | - Pascal Vaast
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- CHU Lille, Clinic of Obstetrics and Gynaecology, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Rony Sfeir
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | | | - Estelle Aubry
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Kévin Le Duc
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Dyuti Sharma
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| |
Collapse
|
6
|
Harting MT, Munson D, Linebarger J, Hirshberg E, Gow KW, Malek MM, Robbins AJ, Turnbull J. Ethical Considerations in Critically Ill Neonatal and Pediatric Patients. J Pediatr Surg 2023; 58:1059-1073. [PMID: 36948932 DOI: 10.1016/j.jpedsurg.2023.02.009] [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: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/19/2023]
Abstract
The care of critically ill neonates and pediatric patients can be particularly emotionally and ethically challenging. Emerging evidence suggests that we can improve the patient, family, and care team experience in the critical care setting through a better understanding and application of ethical frameworks and communication strategies. We conducted a multidisciplinary panel session at the American Academy of Pediatrics National Conference and Exhibition in the fall of 2022 wherein we explored a myriad of ethical and communication considerations in this unique patient population, with congenital diaphragmatic hernia (CDH) as the congenital anomaly/disease framework. In this review, we will cover state of the art topics in ethics, communication, and palliative care including basic terminology, communication strategies such as trauma-informed communication, establishing/evolving goals of care, futility, medically inappropriate treatment, ethical frameworks, parental discretion, establishing milestones, internal/external intentions, and re-direction of care. These topics will be helpful to many specialties who are involved in the care of critically ill neonates and children including maternal fetal medicine, pediatrics, neonatology, pediatric critical care, palliative care, and pediatric surgery, along with the pediatric surgical subspecialties. We use a theoretical CDH case as an example and include the live audience responses from the interactive session. This primer provides overarching educational principles, as well as practical communication concepts, that can cultivate compassionate multidisciplinary teams, equipped to optimize family-centered, evidence-based compassionate communication and care.
Collapse
Affiliation(s)
- Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA.
| | - David Munson
- Department of Pediatrics, Division of Neonatology, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer Linebarger
- Department of Pediatrics, University of Missouri - Kansas City and Children's Mercy Hospital, Kansas City, MO, USA
| | - Ellie Hirshberg
- Department of Pediatrics, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kenneth W Gow
- Department of Surgery, Division of Pediatric Surgery, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Marcus M Malek
- Department of Surgery, Division of Pediatric Surgery, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandria J Robbins
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Family Medicine and Community Health, Division of Palliative Care, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jessica Turnbull
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
7
|
Valfré L, Conforti A, Morini F, Patel N, Bevilacqua F, Cianci MC, Bagolan P, Braguglia A. Unsolved problems in CDH follow-up. Front Pediatr 2022; 10:977354. [PMID: 36389367 PMCID: PMC9645578 DOI: 10.3389/fped.2022.977354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
In patients affected by CDH, survival beyond the neonatal period continues to increase thanks to technological and pharmacological improvements. Conversely, patients, families and caregivers are more and more frequently facing "new" complex late comorbidities, including chronic pulmonary and cardiac dysfunctions, neurodevelopmental challenges, and specific nutritional requirements, that often require ongoing long-term medical or surgical care. Therefore, late morbidity is now a key focus in clinical care of CDH. The aims of this paper are to stress some of the most important "unsolved problems" for CDH patients at long-term follow-up.
Collapse
Affiliation(s)
- Laura Valfré
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Francesca Bevilacqua
- Unit of Clinical Psychology, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Annabella Braguglia
- Neonatal Intermediate Care Unit and Follow-Up, Medical and Surgical Department of Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|