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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.
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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
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Piersigilli F, Syed M, Lam TT, Dotta A, Massoud M, Vernocchi P, Quagliariello A, Putignani L, Auriti C, Salvatori G, Bagolan P, Bhandari V. An omic approach to congenital diaphragmatic hernia: a pilot study of genomic, microRNA, and metabolomic profiling. J Perinatol 2020; 40:952-961. [PMID: 32080334 DOI: 10.1038/s41372-020-0623-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The omic approach can help identify a signature that can be potentially used as biomarkers in babies with congenital diaphragmatic hernia (CDH). OBJECTIVES To find a specific microRNA (miR) and metabolic fingerprint of the tracheal aspirates (TA) of CDH patients. We conducted a genetic analysis from blood samples. METHODS TA samples collected in the first 48 h of life in patients with CDH, compared with age-matched controls. Metabolomics done by a mass spectroscopy-based assay. Genomics done using chromosomal microarray analysis. RESULTS CDH (n = 17) and 16 control neonates enrolled. miR-16, miR-17, miR-18, miR-19b, and miR-20a had an increased expression, while miR-19a had a twofold decreased expression in CDH patients, compared with age-matched control patients. Specific metabolites separated neonates with CDH from controls. A genetic mutation found in a small subset of patients. CONCLUSIONS Specific patterns of metabolites and miR expression can be discerned in TA samples in infants with CDH.
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Affiliation(s)
- Fiammetta Piersigilli
- Division of Perinatal Medicine, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mansoor Syed
- Division of Perinatal Medicine, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Section of Neonatal-Perinatal Medicine, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA, 19134, USA
| | - TuKiet T Lam
- Department of Molecular Biophysics & Biochemistry, Yale University, New Haven, CT, USA.,Keck MS & Proteomics Resource, WM Keck Foundation Biotechnology Resource Laboratory, New Haven, CT, USA
| | - Andrea Dotta
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michela Massoud
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pamela Vernocchi
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Quagliariello
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorenza Putignani
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy.,Unit of Parasitology, Department of Laboratory and Immunological, Diagnostics Bambino Gesù Children's Hospital, Rome, Italy
| | - Cinzia Auriti
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guglielmo Salvatori
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vineet Bhandari
- Division of Perinatal Medicine, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. .,Section of Neonatal-Perinatal Medicine, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA, 19134, USA. .,Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA.
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Prat-Ortells J, Tarrado X. The primary care of a patient with a history of a gastrointestinal malformation and abdominal wall or diaphragmatic defects. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Salvatori G, Foligno S, Massoud M, Piersigilli F, Bagolan P, Dotta A. The experience of breastfeeding infants affected by congenital diaphragmatic hernia or esophageal atresia. Ital J Pediatr 2018; 44:75. [PMID: 29970173 PMCID: PMC6029120 DOI: 10.1186/s13052-018-0509-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background Newborns with congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) might experience breastfeeding difficulties. The aim of this study was to detect the prevalence of breastfeeding in newborns with CDH and EA at different time points. Methods We performed an epidemiological study and retrospective survey on the prevalence of breastfeeding in CDH and EA affected newborns. We identified 40 CDH and 25 EA newborns who were fed through breastfeeding procedures according to WHO categorized definitions, and compared the breastfeeding procedures at the beginning of hospitalization and at three months of life. Results Although all the mothers attempted breastfeeding after birth, only 44 (67.7%) were still breastfeeding at the time of discharge. Exclusive breastfeeding was successful for only 19 (29%) mothers. The rate of exclusive breastfeeding at three months of life did not differ statistically from discharge and between the two groups of study. Conclusion A large percentage of mothers of children with CDH and EA who breastfed at the beginning of hospitalization did not continue at three months. It would be important to increase the breastfeeding rate in CDH and EA affected newborns by following specific steps for vulnerable infants and sustaining breastfeeding after discharge.
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Affiliation(s)
- G Salvatori
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
| | - S Foligno
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - M Massoud
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - F Piersigilli
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - P Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - A Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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Barrière F, Michel F, Loundou AD, Fouquet V, Kermorvant E, Blanc S, Carricaburu E, Desrumaux A, Pidoux O, Arnaud A, Berte N, Blanc T, Lavrand F, Levard G, Rayet I, Samperiz S, Schneider A, Marcoux MO, Winer N, Chaussy Y, Datin-Dorriere V, Ballouhey Q, Binet A, Muszynski C, Breaud J, Garenne A, Storme L, Boubnova J. One-Year Outcome for Congenital Diaphragmatic Hernia: Results From the French National Register. J Pediatr 2018; 193:204-210. [PMID: 29212620 DOI: 10.1016/j.jpeds.2017.09.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 08/11/2017] [Accepted: 09/27/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the status of congenital diaphragmatic hernia (CDH) management in France and to assess predictors of adverse outcomes. STUDY DESIGN We reviewed the first-year outcome of all cases of CDH reported to the French National Register in 2011. RESULTS A total of 158 cases were included. Of these, 83% (131) were prenatally diagnosed, with a mortality rate of 39% (44 of 112) for live born infants with a known outcome at hospital discharge. Mortality increased to 47% (60 of 128) including those with termination of pregnancy and fetal loss. This contrasts with the 7% (2 of 27) mortality rate of the patients diagnosed postnatally (P = .002). Mortality worsened with 1 prenatal marker of CDH severity (OR 3.38 [1.30-8.83] P = .013) and worsened further with 2 markers (OR 20.64 [5.29-80.62] P < .001). Classic postnatal risk factors of mortality such as side of hernia (nonleft P = .001), prematurity (P < .001), low birth weight (P = .002), and size of the defect (P < .001) were confirmed. Of the 141 live births (114 prenatal and 27 postnatal diagnosis) with known outcomes, 93 (67%) survived to hospital discharge, 68 (60%) with a prenatal diagnosis and 25 (93%) with a postnatal diagnosis. The median time to hospital discharge was 34 days (IQR, 19.25-62). Of these survivors, 71 (76%) were followed up for 1 year. CONCLUSIONS Despite advances in management of CDH, mortality was high and associated with prenatal risk factors. Postnatally, severe persistent pulmonary hypertension was difficult to predict and presented persistent challenges in management.
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Affiliation(s)
- François Barrière
- Pediatric Intensive Care Unit, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
| | - Fabrice Michel
- Pediatric Intensive Care Unit, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Anderson D Loundou
- Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Paris South University Hospitals, AP-HP, Le Kremlin-Bicêtre, France
| | - Elsa Kermorvant
- Neonatal Intensive Care Unit, Necker-Enfants Malades, AP-HP, Paris Descartes University, Paris, France
| | - Sébastien Blanc
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France
| | | | - Amélie Desrumaux
- Neonatal Intensive Care Unit, Couple-Enfant Hospital, Grenoble, France
| | - Odile Pidoux
- Department of Neonatology, University Hospital, Montpellier, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Hôpital Sud, University Hospital, Rennes, France
| | - Nicolas Berte
- Department of Surgery, University Hospital, Nancy, France
| | - Thierry Blanc
- Neonatal Intensive Care Unit, University Hospital, Rouen, France
| | - Frederic Lavrand
- Department of Pediatric Surgery, University of Bordeaux, Pellegrin-Enfant Hospital, Bordeaux, France
| | - Guillaume Levard
- Department of Pediatric Surgery, University Hospital, Poitiers, France
| | - Isabelle Rayet
- Neonatal and Pediatric Intensive Care Unit, Hôpital Nord, Saint-Etienne, France
| | - Sylvain Samperiz
- Neonatal and Pediatric Intensive Care Unit, Felix Guyon Hospital, La Réunion, France
| | - Anne Schneider
- Department of Pediatric Surgery, Hautepierre Hospital University Medical Center, Strasbourg, France
| | | | - Norbert Winer
- Department of Gynecology and Obstetrics, Hôtel-Dieu University Hospital, Nantes, France
| | - Yann Chaussy
- Department of Pediatric Surgery, Jean Minjoz University Hospital, Besançon, France
| | | | - Quentin Ballouhey
- Department of Pediatric Surgery, University Hospital, Limoges, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Clocheville University Hospital, Tours, France
| | - Charles Muszynski
- Department of Obstetrics and Gynecology, Amiens University Hospital, Amiens, France
| | - Jean Breaud
- Department of Pediatric Surgery, Nice Pediatric Hospital, University of Nice-Sophia Antipolis, Nice, France
| | - Armelle Garenne
- Pediatric Department, Brest University Hospital, Brest, France
| | - Laurent Storme
- Department of Neonatal Medicine, Lille University Hospital, Lille, France
| | - Julia Boubnova
- Department of Pediatric Surgery, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
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Hemidiaphragmatic Hernia and Volvulus in a 94-Year-Old Woman. Am J Med 2017; 130:e395-e396. [PMID: 28344148 DOI: 10.1016/j.amjmed.2017.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
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