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Gowda SH, Patel N. "Heart of the Matter": Cardiac Dysfunction in Congenital Diaphragmatic Hernia. Am J Perinatol 2024; 41:e1709-e1716. [PMID: 37011900 DOI: 10.1055/a-2067-7925] [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] [Indexed: 04/05/2023]
Abstract
Despite advances in caring for neonates with congenital diaphragmatic hernia (CDH), mortality and morbidity continues to be high. Additionally, the pathophysiology of cardiac dysfunction in this condition is poorly understood. Postnatal cardiac dysfunction in neonates with CDH may be multifactorial with origins in fetal life. Mechanical obstruction, competition from herniated abdominal organs into thoracic cavity combined with redirection of ductus venosus flow away from patent foramen ovale leading to smaller left-sided structures may be a contributing factor. This shunting decreases left atrial and left ventricular blood volume, which may result in altered micro- and macrovascular aberrations affecting cardiac development in the prenatal period. Direct mass effect from herniated intra-abdominal contents restricting cardiac growth and/or reduced left ventricular preload may contribute independently to left ventricular dysfunction in the absence of right ventricular dysfunction and or pulmonary hypertension. With variable clinical phenotypes of cardiac dysfunction, pulmonary hypertension, and respiratory failure in patients with CDH, there is increased need for individualized diagnosis and tailored therapy. Routine use of therapy such as inhaled nitric oxide and sildenafil that induces significant pulmonary vasodilation may be detrimental in left ventricle dysfunction, whereas in a patient with pure right ventricle dysfunction, they may be beneficial. Targeted functional echocardiography serves as a real-time tool for defining the pathophysiology and aids optimization of vasoactive therapy in affected neonates. KEY POINTS: · Cardiac dysfunction in neonates with CDH is multifactorial.. · Postnatal cardiac dysfunction in patients with CDH has its origins in fetal life.. · Right ventricular dysfunction contributes to systemic hypotension.. · Left ventricular dysfunction contributes to systemic hypotension.. · Supportive therapy should be tailored to clinical phenotype..
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MESH Headings
- Humans
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/physiopathology
- Infant, Newborn
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/diagnostic imaging
- Echocardiography
- Nitric Oxide
- Hernia, Diaphragmatic/complications
- Hernia, Diaphragmatic/physiopathology
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Affiliation(s)
- Sharada H Gowda
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
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2
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Stewart LA, Hernan RR, Mardy C, Hahn E, Chung WK, Bacha EA, Krishnamurthy G, Duron VP, Krishnan US. Congenital Heart Disease with Congenital Diaphragmatic Hernia: Surgical Decision Making and Outcomes. J Pediatr 2023; 260:113530. [PMID: 37268035 PMCID: PMC10527207 DOI: 10.1016/j.jpeds.2023.113530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the types of congenital heart disease (CHD) in a congenital diaphragmatic hernia (CDH) cohort in a large volume center and evaluate surgical decision making and outcomes based on complexity of CHD and associated conditions. STUDY DESIGN A retrospective review of patients with CHD and CDH diagnosed by echocardiogram between 01/01/2005 and 07/31/2021. The cohort was divided into 2 groups based on survival at discharge. RESULTS Clinically important CHD was diagnosed in 19% (62/326) of CDH patients. There was 90% (18/20) survival in children undergoing surgery for both CHD and CDH as neonates, and 87.5 (22/24) in those undergoing repair initially for CDH alone. A genetic anomaly identified on clinical testing was noted in 16% with no significant association with survival. A higher frequency of other organ system anomalies was noted in nonsurvivors compared with survivors. Nonsurvivors were more likely to have unrepaired CDH (69% vs 0%, P < .001) and unrepaired CHD (88% vs 54%, P < .05), reflecting a decision not to offer surgery. CONCLUSIONS Survival was excellent in patients who underwent repair of both CHD and CDH. Patients with univentricular physiology have poor survival and this finding should be incorporated into pre and postnatal counseling about eligibility for surgery. In contrast, patients with other complex lesions including transposition of the great arteries have excellent outcomes and survival at 5 years follow-up at a large pediatric and cardiothoracic surgical center.
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Affiliation(s)
- Latoya A Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Rebecca R Hernan
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Christopher Mardy
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Eunice Hahn
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Emile A Bacha
- Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Ganga Krishnamurthy
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Vincent P Duron
- Division of Pediatric Surgery, Columbia University Irving Medical Center, New York, NY
| | - Usha S Krishnan
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY; Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY.
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3
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Gowda SH, Almaazmi A, Hagan J, Niemyjski E, Vogel AM, Jancelewicz T, Di Nardo M, Harting MT, Fernandes CJ, Nguyen DV, Guner YS. Inhaled Nitric Oxide Utilization in Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: A Propensity Score Analysis. ASAIO J 2023; 69:504-510. [PMID: 37040072 DOI: 10.1097/mat.0000000000001901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Although used commonly, ability of inhaled nitric oxide (iNO) to improve outcomes in infants with congenital diaphragmatic hernia (CDH) who receive extracorporeal life support (ECLS) remains controversial. We sought to determine the association between pre-ECLS use of iNO and mortality in infants with CDH from the Extracorporeal Life Support Organization (ELSO) Registry. Neonates who underwent ECLS for CDH were identified from the ELSO Registry from 2009 to 2019. Patients were categorized into those treated with iNO versus not prior to initiating ECLS. Patients were then matched 1:1 for case-mix based on pre-ECLS covariates using the propensity score (PS) for iNO treatment. The matched groups were compared for mortality. The matched cohorts were also compared for ELSO-defined systems-based complications as secondary outcomes. There were a total of 3,041 infants with an overall mortality of 52.2% and a pre-ECLS iNO use rate of 84.8%. With 1:1 matching, there were 461 infants with iNO use and 461 without iNO use. Following matching, use of iNO was not associated with a difference in mortality (odds ratio [OR] = 0.805; 95% confidence interval [CI], 0.621-1.042; p = 0.114). Results were similar in unadjusted analyses, and after controlling for covariates in the full cohort of patients and in the 1:1 matched data. Patients receiving iNO had significantly higher odds of renal complications (OR = 1.516; 95% CI, 1.141-2.014; p = 0.004), but no other significant differences were observed among secondary outcomes. ECLS use of iNO in CDH patients was not associated with a difference in mortality. Future randomized controlled studies are needed to delineate the utility of iNO in CDH patients.
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Affiliation(s)
- Sharada H Gowda
- From the Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ahmed Almaazmi
- From the Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Joseph Hagan
- From the Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Emily Niemyjski
- From the Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Adam M Vogel
- From the Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Tim Jancelewicz
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matthew T Harting
- Department of Pediatric Surgery, University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Caraciolo J Fernandes
- From the Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Danh V Nguyen
- Department of Medicine, University of California Irvine, Irvine, California
| | - Yigit S Guner
- Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, California
- Department of Surgery, University of California Irvine Medical Center, Orange, California
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4
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Bronicki RA, Benitz WE, Buckley JR, Yarlagadda VV, Porta NFM, Agana DO, Kim M, Costello JM. Respiratory Care for Neonates With Congenital Heart Disease. Pediatrics 2022; 150:189881. [PMID: 36317970 DOI: 10.1542/peds.2022-056415h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ronald A Bronicki
- Baylor College of Medicine, Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, Texas
| | - William E Benitz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California
| | - Jason R Buckley
- Medical University of South Carolina, Divison of Pediatric Cardiology, Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Vamsi V Yarlagadda
- Stanford School of Medicine, Division of Cardiology, Lucile Packard Children's Hospital, Palo Alto, California
| | - Nicolas F M Porta
- Northwestern University Feinberg School of Medicine, Division of Neonatology, Pediatric Pulmonary Hypertension Program, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Devon O Agana
- Mayo Clinic College of Medicine and Science, Department of Anesthesiology and Pediatric Critical Care Medicine, Mayo Eugenio Litta Children's Hospital, Rochester, Minnesota
| | - Minso Kim
- University of California San Francisco School of Medicine, Division of Critical Care, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - John M Costello
- Medical University of South Carolina, Divison of Pediatric Cardiology, Shawn Jenkins Children's Hospital, Charleston, South Carolina
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5
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Molecular Mechanisms Contributing to the Etiology of Congenital Diaphragmatic Hernia: A Review and Novel Cases. J Pediatr 2022; 246:251-265.e2. [PMID: 35314152 DOI: 10.1016/j.jpeds.2022.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 12/25/2022]
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Manandhar SR, Shrestha AL, Shrestha S, Basnet R. Diaphragmatic Hernia in a Preterm with Congenital Heart Defects with Successful Outcome: A Case Report. JNMA J Nepal Med Assoc 2022; 60:565-568. [PMID: 35690978 PMCID: PMC9275456 DOI: 10.31729/jnma.7462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022] Open
Abstract
Congenital diaphragmatic hernia is an anatomical defect of the diaphragm that is often associated with serious cardiopulmonary complications. It can also be associated with many other problems like multi systemic anomalies, chromosomal aneuploidy and prematurity. Of these, cardiac defects, liver herniation and prematurity seem to have a pivotal role in affecting the outcomes of repair. We hereby present a preterm newborn with such multiple defects repaired on 15th day of life and post operatively managed in a Neonatal Intensive Care Unit with a successful outcome. The key learning objective for our team in this case was to identify the steps taken that led to a successful management of a low birth weight preemie with multiple defects in a resource limited set up. Keywords congenital diaphragmatic hernia; preterm; surgical repair; ventricular septal defect.
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Affiliation(s)
- Sunil Raja Manandhar
- Neonatology Unit, Department of Pediatrics, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal,Correspondence: Dr Sunil Raja Manandhar, Neonatal Unit, Department of Pediatrics, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9803812218
| | - Ashish Lal Shrestha
- Department of Pediatric and Neonatal Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sabina Shrestha
- Neonatology Unit, Department of Pediatrics, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Rydam Basnet
- Neonatology Unit, Department of Pediatrics, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Scott DA, Gofin Y, Berry AM, Adams AD. Underlying genetic etiologies of congenital diaphragmatic hernia. Prenat Diagn 2022; 42:373-386. [PMID: 35037267 PMCID: PMC8924940 DOI: 10.1002/pd.6099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is often detectable prenatally. Advances in genetic testing have made it possible to obtain a molecular diagnosis in many fetuses with CDH. Here, we review the aneuploidies, copy number variants (CNVs), and single genes that have been clearly associated with CDH. We suggest that array-based CNV analysis, with or without a chromosome analysis, is the optimal test for identifying chromosomal abnormalities and CNVs in fetuses with CDH. To identify causative sequence variants, whole exome sequencing (WES) is the most comprehensive strategy currently available. Whole genome sequencing (WGS) with CNV analysis has the potential to become the most efficient and effective means of identifying an underlying diagnosis but is not yet routinely available for prenatal diagnosis. We describe how to overcome and address the diagnostic and clinical uncertainty that may remain after genetic testing, and review how a molecular diagnosis may impact recurrence risk estimations, mortality rates, and the availability and outcomes of fetal therapy. We conclude that after the prenatal detection of CDH, patients should be counseled about the possible genetic causes of the CDH, and the genetic testing modalities available to them, in accordance with generally accepted guidelines for pretest counseling in the prenatal setting.
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Affiliation(s)
- Daryl A. Scott
- Texas Children’s Hospital, Houston, TX, 77030,
USA,Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, TX, 77030, USA,Department of Molecular Physiology and Biophysics, Baylor
College of Medicine, Houston, TX, 77030, USA,Correspondence: Daryl A. Scott, R813, One Baylor
Plaza. BCM225, Houston, TX 77030, USA, Phone: +1 713-203-7242,
| | - Yoel Gofin
- Texas Children’s Hospital, Houston, TX, 77030,
USA,Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, TX, 77030, USA
| | - Aliska M. Berry
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, TX, 77030, USA
| | - April D. Adams
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, TX, 77030, USA,Department of Obstetrics and Gynecology, Division of
Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
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8
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Moon-Grady AJ, Byrne FA, Lusk LA, Keller RL. Expected small left heart size in the presence of congenital diaphragmatic hernia: Fetal values and Z-scores for infants confirmed to have no heart disease postnatally. Front Pediatr 2022; 10:1083370. [PMID: 36561485 PMCID: PMC9763578 DOI: 10.3389/fped.2022.1083370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES In fetuses with left-sided congenital diaphragmatic hernia (CDH), left heart structures may appear small, but usually normalize after birth in the absence of structural cardiac anomalies. To decrease the possibility of an erroneous diagnosis of structural heart disease, we identify normal values for left heart structures in the presence of left CDH and secondarily investigate the relationship of left heart size and survival to neonatal hospital discharge. METHODS Left heart structures [mitral valve (MV) and aortic valve (AoV) annulus diameter, left ventricle (LV) length and width] were measured by fetal echocardiogram in fetuses with left CDH and no congenital heart disease. We generated linear regression models to establish the relationship of gestational age for each left heart structure using data from fetuses who survived after birth. We calculated z-scores (normalized to gestational age), and assessed the relationship of survival to the size of each structure. RESULTS One hundred forty-two fetuses underwent fetal echocardiogram (median 25 weeks' gestation, IQR 23, 27 weeks). Left heart structures were deemed small when using published normative data from unaffected fetuses (z-scores: MV -1.09 ± 1.35, AoV -2.12 ± 1.16, LV length -1.36 ± 1.24, LV width -4.79 ± 0.79). CDH-specific models derived from log-transformed values yielded left-shifted distributions, reflecting the small structures (mean z-score lower by: MV 0.99 ± 0.30, AoV 2.04 ± 0.38, LV length 1.30 ± 0.36, and LV width 4.69 ± 0.28; p < 0.0001 for all comparisons). Non-survivors had worse z-scores than survivors for all measurements, but this did not reach statistical significance. CONCLUSIONS Log-transformed linear models generated new normative data for fetal left heart structures in left CDH, which may be used to allay antenatal concerns regarding structural left heart anomalies. There were no significant differences in z-scores between survivors and non-survivors, suggesting that in the absence of true structural disease, cardiac evaluation is not predictive in isolation and that causes of mortality are likely multifactorial in this population.
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Affiliation(s)
- Anita J Moon-Grady
- Division of Pediatric Cardiology, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, United States.,Fetal Treatment Center, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, United States
| | - Francesca A Byrne
- Pacific Cardiovascular Associates, Pediatric Cardiology, Orange, CA, United States
| | - Leslie A Lusk
- Division of Neonatology, Department of Pediatrics UCSF Benioff Children's Hospital, Oakland, CA, United States
| | - Roberta L Keller
- Fetal Treatment Center, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, United States.,Division of Neonatology, University of California San Francisco, Benioff Children's Hospital, San Francisco CA, United States
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9
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Jawaid W, Sampat K, Losty PD. Does the Presence of a Hernia Sac Improve Survival in Newborns with Congenital Diaphragmatic Hernia? A United Kingdom Single-Center Experience. Eur J Pediatr Surg 2021; 31:276-281. [PMID: 32526780 DOI: 10.1055/s-0040-1713131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION A developing body of literature suggests that the presence of a hernia sac in fetuses with congenital diaphragmatic hernia (CDH) may indicate improved prognosis. By examining a large cohort of CDH newborns admitted to a single United Kingdom specialist center, we aimed to establish if presence of hernia sac is a robust predictor of improved survival. MATERIALS AND METHODS All CDH patients admitted to a single center were recruited. Postneonatal presentations and Morgagni hernias were excluded. Demographics, defect type, laterality, survival, and hernia recurrence were recorded. RESULTS In this study, 192 CDH newborns were managed from 1997 to 2017; 39 were excluded (10 Morgagni and 29 postneonatal); 22 (14%) neonates had a hernia sac. Survival in patients with a hernia sac was 21/22 (95%) versus 107/124 (86%) in cases without hernia sac (p = 0.2). There was no difference in hernia sac proportion by gender (male:female 15 vs. 13.2%, p = 0.8). CONCLUSION In contrast to studies showing a survival advantage, albeit with smaller patient numbers, we report a statistical nonsignificant benefit of hernia sac. Better survival outcomes at this specialist center with CDH patients without a hernia sac than reported in other published studies are likely responsible for the lack of statistical significance observed, despite a larger cohort. National and international CDH registries yielding "big data" may provide further answers on the utility of a CDH hernia sac as a new prognostic scoring tool.
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Affiliation(s)
- Wajid Jawaid
- Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kit Sampat
- Division of Child Health, Institute of Child Health, Alder Hey Children' Hospital, University of Liverpool, Liverpool, United Kingdom
| | - Paul D Losty
- Division of Child Health, Institute of Child Health, Alder Hey Children' Hospital, University of Liverpool, Liverpool, United Kingdom
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10
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Shetty S, Arattu Thodika FMS, Greenough A. Managing respiratory complications in infants and newborns with congenital diaphragmatic hernia. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1865915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Anne Greenough
- Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, London, UK
- Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK
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Impacts of Respiratory Muscle Training on Respiratory Functions, Maximal Exercise Capacity, Functional Performance, and Quality of Life in School-Aged Children with Postoperative Congenital Diaphragmatic Hernia. DISEASE MARKERS 2020; 2020:8829373. [PMID: 32963638 PMCID: PMC7492875 DOI: 10.1155/2020/8829373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/09/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022]
Abstract
Objectives Congenital diaphragmatic hernia (CDH) is a birth defect affecting the respiratory functions, functional performance, and quality of life (QOL) in school-aged children. Rarely have studies been conducted to evaluate the impacts of respiratory muscle training on school-aged children with postoperative CDH. The current study was designed to evaluate the impacts of respiratory muscle training on respiratory function, maximal exercise capacity, functional performance, and QOL in these children. Methods This study is a randomized control study. 40 children with CDH (age: 9-11 years) were assigned randomly into two groups. The first group conducted an incentive spirometer exercise combined with inspiratory muscle training (study group, n = 20), whereas the second group conducted only incentive spirometer exercise (control group, n = 20), thrice weekly for twelve consecutive weeks. Respiratory functions, maximal exercise capacity, functional performance, and pediatric quality of life inventory (PedsQL) were assessed before and after the treatment program. Results. Regarding the posttreatment analysis, the study group showed significant improvements in all outcome measures (FVC%, p < 0.001; FEV1%, p = 0.002; VO2max, p = 0.008; VE/VCO2 slope, p = 0.002; 6-MWT, p < 0.001; and PedsQL, p < 0.001), whereas the control group did not show significant changes (p > 0.05). Conclusion Respiratory muscle training may improve respiratory functions, maximal exercise capacities, functional performance, and QOL in children with postoperative CDH. Clinical commendations have to be considered to include respiratory muscle training in pulmonary rehabilitation programs in children with a history of CDH.
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12
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Montalva L, Lauriti G, Zani A. Congenital heart disease associated with congenital diaphragmatic hernia: A systematic review on incidence, prenatal diagnosis, management, and outcome. J Pediatr Surg 2019; 54:909-919. [PMID: 30826117 DOI: 10.1016/j.jpedsurg.2019.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/27/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of congenital heart disease (CHD) on infants with congenital diaphragmatic hernia (CDH). METHODS Using a defined search strategy (PubMed, Cochrane, Embase, Web of Science MeSH headings), we searched studies reporting the incidence, management, and outcome of CDH infants born with associated CHD. RESULTS Of 6410 abstracts, 117 met criteria. Overall, out of 28,974 babies with CDH, 4427 (15%) had CHD, of which 42% were critical. CDH repair was performed in a lower proportion of infants with CHD (72%) than in those without (85%; p < 0.0001). Compared to CDH babies without CHD, those born with a cardiac lesion were more likely to have a patch repair (45% vs. 30%; p < 0.01) and less likely to undergo minimally invasive surgery (5% vs. 17%; p < 0.0001). CDH babies with CHD had a lower survival rate than those without CHD (52 vs. 73%; p < 0.001). Survival was even lower (32%) in babies with critical CHD. CONCLUSION CHD has a strong impact on the management and outcome of infants with CDH. The combination of CDH and CHD results in lower survival than those without CHD or an isolated cardiac defect. Further studies are needed to address some specific aspects of the management of this fragile CDH cohort. TYPE OF STUDY Systematic review and meta-analysis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Louise Montalva
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, and "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
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13
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Wang Y, Honeyford K, Aylin P, Bottle A, Giuliani S. One-year outcomes for congenital diaphragmatic hernia. BJS Open 2019; 3:305-313. [PMID: 31183446 PMCID: PMC6551417 DOI: 10.1002/bjs5.50135] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and long‐term morbidity. The aim of this study was to benchmark trends in 1‐year and hospital volume outcomes for this condition. Methods This study included all infants born with CDH in England between 2003 and 2016. This was a retrospective analysis of the Hospital Episode Statistics database. The main outcomes were: 1‐year mortality, neonatal length of hospital stay (nLOS), total bed‐days at 1 year and readmission rate. The association between hospital volume and outcomes was assessed for specialist paediatric surgery centres. Results A total of 2336 infants were included (incidence 2·5 per 10 000 live births). No significant time trends were found in incidence and main outcomes. Some 1491 infants (63·8 per cent) underwent surgical repair. The 1‐year mortality rate was 31·2 per cent. Median nLOS and total bed‐days were 17 and 19 days respectively. The readmission rate in specialist paediatric centres was 6·3 per cent. Higher mortality was associated with birthweight lower than 1 kg (OR 5·90, 95 per cent c.i. 1·03 to 33·75), gestational age of 36 weeks or less (OR 1·75, 1·12 to 2·75) and black ethnicity (OR 2·13, 1·03 to 4·48). Only 4·0 per cent had extracorporeal membrane oxygenation, which was associated with higher mortality (OR 5·34, 3·01 to 9·46), longer nLOS (OR 3·70, 2·14 to 6·14) and longer total bed‐days (OR 3·87, 2·19 to 6·83). Specialist paediatric centres showed variation in 30‐day mortality (4·6 per cent with 84 per cent coefficient of variation), nLOS (median 25 (i.q.r. 15–42) days) and total bed‐days (median 28 (i.q.r. 16–51) days), but no significant volume–outcome relationship. Conclusion Key outcomes for CDH were similar to those of other developed countries. High variation among specialist paediatric centres was found and should be investigated further to explore the value of regionalization of care.
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Affiliation(s)
- Y Wang
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - K Honeyford
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - P Aylin
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - A Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - S Giuliani
- Department of Specialist Neonatal and Paediatric Surgery Great Ormond Street Hospital for Children NHS Foundation Trust London UK
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14
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Schierz IAM, Giuffrè M, Piro E, Leone MC, Pinello G, Corsello G. Clinical cardiac assessment in newborns with prenatally diagnosed intrathoracic masses. Ital J Pediatr 2018; 44:98. [PMID: 30134984 PMCID: PMC6106891 DOI: 10.1186/s13052-018-0543-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background Congenital space-occupying thoracic malformations and diaphragmatic hernia have in common pulmonary hypoplasia. Our study aims to assess cardiac involvement during post-natal adaptation. Methods A retrospective study was carried out on newborns with prenatally diagnosed intrathoracic mass. Gathering for respiratory distress syndrome (RDS), 35 neonates were compared for clinical course, cardiovascular enzymes, ECG, and ultrasound. Results The analysis revealed a high left heart defect rate in patients with severe RDS, without being influenced by the laterality. Ultrasound or laboratory assessment did not detect altered cardiac dimension or cardiomyopathy. Solely ECG signs of right ventricular strain were found. Increased QT-dispersion, T-wave and cardiac variability alterations in the first hours were all expression of non-specific cardiac repolarization disorders but predict worse outcome. Conclusions Although RDS is the predominant symptom, slight cardiac dysfunctions should be recognized for prompt treatment. Conventional examinations for postnatal adaption should be integrated by complementary investigations.
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15
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Russo FM, Cordier AG, De Catte L, Saada J, Benachi A, Deprest J. Proposal for standardized prenatal ultrasound assessment of the fetus with congenital diaphragmatic hernia by the European reference network on rare inherited and congenital anomalies (ERNICA). Prenat Diagn 2018; 38:629-637. [PMID: 29924391 DOI: 10.1002/pd.5297] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/02/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022]
Abstract
Congenital diaphragmatic hernia is a rare disease associated with high mortality and morbidity. Antenatal ultrasound screening identifies more than 70% of cases, providing the opportunity for in utero referral to a tertiary care center for expert assessment and perinatal management. Additional genetic and morphologic assessment may be used to rule out associated anomalies. In isolated cases, the outcome may be predicted prenatally by medical imaging. The combination of lung size and liver herniation is a widely accepted method to stratify fetuses into groups with an increasing degree of pulmonary hypoplasia and corresponding mortality rates. Ultrasound measurement of the observed to expected lung-to-head ratio (o/e LHR) is most widely used. The o/e LHR is an independent predictor of survival and short-term morbidity. Finally, evaluation of stomach position has recently been introduced as an indirect method to estimate severity of the disease in left-sided defects, as it has been shown to correlate with the proportion of intrathoracic liver. Herein, we propose a protocol for the standardized ultrasound assessment of fetuses with isolated CDH and individualized prediction of neonatal outcome.
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Affiliation(s)
- Francesca Maria Russo
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Anne-Gael Cordier
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, AP-HP, Université Paris Sud, Clamart, France
| | - Luc De Catte
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Julien Saada
- Centre Référence Maladie Rare: Hernie de Coupole Diaphragmatique, Clamart, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, AP-HP, Université Paris Sud, Clamart, France.,Centre Référence Maladie Rare: Hernie de Coupole Diaphragmatique, Clamart, France
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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16
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Balduf K, Kumar TKS, Boston U, Sathanandam S, Lee MV, Jancelewicz T, Knott-Craig CJ. Improved Outcomes in Management of Hypoplastic Left Heart Syndrome Associated With Congenital Diaphragmatic Hernia: an Algorithmic Approach. Semin Thorac Cardiovasc Surg 2018; 30:191-196. [PMID: 29448010 DOI: 10.1053/j.semtcvs.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/27/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is the second most common congenital heart disease associated with congenital diaphragmatic hernia (CDH). The reported survival rate of neonates with CDH and HLHS is only 1%-5%. We review our experience with CDH and HLHS and compare our outcomes with published literature. Retrospective review of all neonates with CDH and HLHS at our institution over a 10-year period was performed. The morphology of cardiac and diaphragm defects, clinical course, treatment strategies, and outcomes were reviewed, and an algorithmic approach was proposed. Five patients with CDH and HLHS were treated between 2006 and 2016. All had mitral stenosis with aortic stenosis. Four patients had a left-sided Bochdalek diaphragmatic hernia and 1 patient had a large bilateral Morgagni hernia. Two (2/4) of the Bochdalek hernias were associated with significant pulmonary hypoplasia and required patch closure of the CDH; both were palliated with percutaneous ductal stents and both died. Three patients underwent primary Norwood operation followed by repair of less severe CDH defect. All 3 patients are currently well and have survived bidirectional Glenn anastomosis; one patient is well after Fontan operation. Successful palliation of neonates with HLHS and associated CDH is possible in the current era. Outcome is determined primarily by the severity of the CDH and the degree of associated pulmonary hypoplasia. An algorithmic team approach is helpful in management of this difficult group of patients.
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Affiliation(s)
- Kaitlin Balduf
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - T K Susheel Kumar
- Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Umar Boston
- Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Shyam Sathanandam
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Marc V Lee
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tim Jancelewicz
- Department of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Christopher J Knott-Craig
- Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
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17
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Chong K, Saleh M, Injeyan M, Miron I, Fong K, Shannon P. Nonisolated diaphragmatic hernia in Simpson-Golabi-Behmel syndrome. Prenat Diagn 2018; 38:117-122. [PMID: 29240237 DOI: 10.1002/pd.5198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/01/2017] [Accepted: 12/09/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) is associated with Simpson-Golabi-Behmel syndrome (SGBS), but few cases diagnosed prenatally have been reported. The aim of this series is to highlight the association of nonisolated CDH with SGBS type I on prenatal ultrasound and emphasize the importance of genetic testing, fetal autopsy, and family history in confirming this diagnosis. METHOD Retrospective review of 3 cases of SGBS type I in a single tertiary care centre. Family history, fetal ultrasound, autopsy findings, and genetic testing for GPC3 was performed for each case. RESULTS Fetal ultrasound findings in the second trimester were CDH, omphalocele, increased nuchal fold, renal anomaly, and cleft lip and palate. Fetal autopsy confirmed the prenatal ultrasound findings and also showed dysmorphic facial features and premalignant lesions on renal and gonadal histology. Microarray and DNA analysis of the GPC3 gene confirmed the diagnosis of SGBS type I in each case. CONCLUSION Nonisolated CDH in a male fetus suggests a diagnosis of SGBS type I. Fetal autopsy, pedigree analysis, and genetic testing for GPC3 are all essential to confirming the diagnosis. The histological findings of ovotestes and nephroblastomatosis indicate that cancer predisposition is established early in fetal life.
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Affiliation(s)
- Karen Chong
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Maha Saleh
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Marie Injeyan
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Ioana Miron
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Katherine Fong
- Department of Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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18
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Hautala J, Karstunen E, Ritvanen A, Rintala R, Mattila IP, Räsänen J, Suominen PK, Ojala T. Congenital diaphragmatic hernia with heart defect has a high risk for hypoplastic left heart syndrome and major extra-cardiac malformations: 10-year national cohort from Finland. Acta Obstet Gynecol Scand 2017; 97:204-211. [DOI: 10.1111/aogs.13274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Johanna Hautala
- Obstetrics, and Gynecology; Women's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Emma Karstunen
- Pediatric Cardiology; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Annukka Ritvanen
- Finnish Register of Congenital Malformations; Information Services Department; National Institute for Health and Welfare THL; Helsinki Finland
| | - Risto Rintala
- Pediatric Surgery; Children's Hospital; Helsinki University and Helsinki University Hospital; Helsinki Finland
| | - Ilkka P. Mattila
- Pediatric Cardiac Surgery; Children's Hospital; Helsinki University and Helsinki University Hospital; Helsinki Finland
| | - Juha Räsänen
- Obstetrics, and Gynecology; Women's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Pertti K. Suominen
- Anesthesia and Intensive Care; Children's Hospital; Helsinki University and Helsinki University Hospital; Helsinki Finland
| | - Tiina Ojala
- Pediatric Cardiology; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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19
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Shanmugam H, Brunelli L, Botto LD, Krikov S, Feldkamp ML. Epidemiology and Prognosis of Congenital Diaphragmatic Hernia: A Population-Based Cohort Study in Utah. Birth Defects Res 2017; 109:1451-1459. [PMID: 28925604 DOI: 10.1002/bdr2.1106] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/27/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a relatively frequent and severe malformation. Population-based data on clinical presentation and associated mortality are scarce. We examined a state-wide cohort of infants with a clinically validated diagnosis of CDH to assess their clinical profile, sociodemographic patterns, and infant mortality. METHODS We identified CDH cases from Utah's statewide population-based surveillance program among the cohort of all pregnancy outcomes (live births, stillbirths, and pregnancy terminations) delivered from 1999 to 2011. Clinical geneticists reviewed all cases and classified them based on etiology (known, unknown), and whether they were isolated, multiple (additional unrelated major malformations or unique minor malformation), or syndromic (genetic, chromosomal). RESULTS CDH occurred in 1 in 3156 births (227/718,990, or 3.17 per 10,000), with no time trend during the 13 years (p = 0.85). CDH was much more common in males (male to female ratio, 1.72:1; p < 0.01). Clinically, 64% of the cases were isolated, 23% were multiples, and 13% were syndromic. Most cases were live born (90%), with fewer stillbirths (7%) and pregnancy terminations (3%). Overall infant mortality was 32.5%, and varied considerably by underlying etiology (isolated 21%; multiple 44%; syndromic 82%). Prognosis was related to specific clinical findings within each etiologic group (e.g., prematurity, low Apgar score, and intrathoracic liver). CONCLUSION This information on specific clinical and etiologic factors associated with prognosis can help clinicians and parents in the complex discussions about care planning and management that often occur in a crisis situation, following the diagnosis of CDH, whether prior or after delivery. Birth Defects Research 109:1451-1459, 2017.© 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Hari Shanmugam
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Luca Brunelli
- Division of Neonatology, Department of Pediatrics, University of Nebraska and Children's Hospital Medical Center, Omaha, Nebraska
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sergey Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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20
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21
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Kardon G, Ackerman KG, McCulley DJ, Shen Y, Wynn J, Shang L, Bogenschutz E, Sun X, Chung WK. Congenital diaphragmatic hernias: from genes to mechanisms to therapies. Dis Model Mech 2017; 10:955-970. [PMID: 28768736 PMCID: PMC5560060 DOI: 10.1242/dmm.028365] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Congenital diaphragmatic hernias (CDHs) and structural anomalies of the diaphragm are a common class of congenital birth defects that are associated with significant morbidity and mortality due to associated pulmonary hypoplasia, pulmonary hypertension and heart failure. In ∼30% of CDH patients, genomic analyses have identified a range of genetic defects, including chromosomal anomalies, copy number variants and sequence variants. The affected genes identified in CDH patients include transcription factors, such as GATA4, ZFPM2, NR2F2 and WT1, and signaling pathway components, including members of the retinoic acid pathway. Mutations in these genes affect diaphragm development and can have pleiotropic effects on pulmonary and cardiac development. New therapies, including fetal endoscopic tracheal occlusion and prenatal transplacental fetal treatments, aim to normalize lung development and pulmonary vascular tone to prevent and treat lung hypoplasia and pulmonary hypertension, respectively. Studies of the association between particular genetic mutations and clinical outcomes should allow us to better understand the origin of this birth defect and to improve our ability to predict and identify patients most likely to benefit from specialized treatment strategies.
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Affiliation(s)
- Gabrielle Kardon
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Kate G Ackerman
- Departments of Pediatrics (Critical Care) and Biomedical Genetics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - David J McCulley
- Department of Pediatrics, University of Wisconsin, Madison, WI 53792, USA
| | - Yufeng Shen
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Julia Wynn
- Departments of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Linshan Shang
- Departments of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Eric Bogenschutz
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Xin Sun
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Wendy K Chung
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
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22
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Lakshmy RS, Agnees J, Rose N. The Upturned Superior Mesenteric Artery Sign for First-Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:583-592. [PMID: 28150314 DOI: 10.7863/ultra.16.04047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to follow the course of the superior mesenteric artery (SMA) in first-trimester fetuses to predict the location of the small bowel. Its abnormal course aids in early detection of congenital diaphragmatic hernia (CDH) and assessment of the contents of omphalocele. METHODS The SMA can be easily identified in a sagittal section of the fetus by using color Doppler sonography at the 11- to 14-week scan, and normally, it has a downward course caudally to supply the intestines. The course of the SMA points to the location of the bowel. RESULTS We report a series of 7 cases detected in first trimester with an abnormal course of the SMA, 3 of which had CDH and 4 of which had omphalocele. In CDH, the intestines herniate into the thoracic cavity; hence, the SMA tends to have an upward course toward the thorax. In 4 cases of omphalocele, the SMA follows the exteriorized bowel into the base of the umbilical cord. CONCLUSIONS Second-trimester sonography for detection of congenital malformations is a standardized protocol, but a careful anatomic survey at the 11- to 14-week scan is often rewarding. When there is a suspicion of an intrathoracic mass or a mediastinal shift, the upturned course of SMA serves as a valuable sign in confirmation of CDH. Chromosomal abnormalities are often reported in cases of omphalocele containing small bowel only, and the upward course of the SMA toward the base of the cord helps in its early prenatal diagnosis, which facilitates early genetic assessment in these fetuses.
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Affiliation(s)
| | - Joy Agnees
- Vinayaka Mission's Kirupananda Variyar Medical College and Hospitals, Salem, India
| | - Nity Rose
- Shri Lakshmi Scan Center, Kaveripattinam, India
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23
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Ibrahim M, Hunter M, Gugasyan L, Chan Y, Malhotra A, Sehgal A, Tan K. Interstitial deletion of chromosome 1 (1p21.1p12) in an infant with congenital diaphragmatic hernia, hydrops fetalis, and interrupted aortic arch. Clin Case Rep 2017; 5:164-169. [PMID: 28174644 PMCID: PMC5290521 DOI: 10.1002/ccr3.759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/28/2016] [Accepted: 11/06/2016] [Indexed: 11/13/2022] Open
Abstract
We report a case of an infant with congenital diaphragmatic hernia (CDH) and hydrops fetalis who died from hypoxic respiratory failure. Autopsy revealed type B interrupted aortic arch (IAA). Microarray revealed a female karyotype with deletion of chromosome 1p21.1p12. There may be an association between 1p microdeletion, CDH, and IAA.
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Affiliation(s)
- Masitah Ibrahim
- Monash Newborn Monash Medical Centre Melbourne Victoria Australia
| | - Matthew Hunter
- Monash Genetics Monash Medical Centre Melbourne Victoria Australia; Department of Paediatrics Monash University Melbourne Victoria Australia
| | - Lucy Gugasyan
- Cytogenetics Laboratory, Pathology Monash Medical Centre Melbourne Victoria Australia
| | - Yuen Chan
- Anatomical Pathology Services Monash Medical Centre Melbourne Victoria Australia
| | - Atul Malhotra
- Monash Newborn Monash Medical Centre Melbourne Victoria Australia; Department of Paediatrics Monash University Melbourne Victoria Australia; The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
| | - Arvind Sehgal
- Monash Newborn Monash Medical Centre Melbourne Victoria Australia; Department of Paediatrics Monash University Melbourne Victoria Australia; The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
| | - Kenneth Tan
- Monash Newborn Monash Medical Centre Melbourne Victoria Australia; Department of Paediatrics Monash University Melbourne Victoria Australia; The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
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24
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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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25
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Unolt M, DiCairano L, Schlechtweg K, Barry J, Howell L, Kasperski S, Nance M, Adzick NS, Zackai EH, McDonald-McGinn DM. Congenital diaphragmatic hernia in 22q11.2 deletion syndrome. Am J Med Genet A 2016; 173:135-142. [PMID: 27682988 DOI: 10.1002/ajmg.a.37980] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 08/29/2016] [Indexed: 11/10/2022]
Abstract
We report the important association of congenital diaphragmatic hernia (CDH) and 22q11.2 deletion syndrome (22q11.2DS). The prevalence of CDH in our cohort of patients with 22q11.2DS is 0.8% (10/1246), which is greater than in the general population (0.025%). This observation suggests that 22q11.2DS should be considered when a child or fetus presents with CDH, in particular when other clinical findings associated with the 22q11.2DS are present, such as congenital cardiac defects. Furthermore, this finding may lead to the identification of an additional locus for diaphragmatic hernia in the general population. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marta Unolt
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Philadelphia, Pennsylvania
| | - Lauren DiCairano
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kathryn Schlechtweg
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica Barry
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stefanie Kasperski
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael Nance
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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26
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Gaur L, Talemal L, Bulas D, Donofrio MT. Utility of fetal magnetic resonance imaging in assessing the fetus with cardiac malposition. Prenat Diagn 2016; 36:752-9. [PMID: 27292912 DOI: 10.1002/pd.4856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/24/2016] [Accepted: 06/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Abnormal cardiac axis and/or malposition prompts evaluation of congenital heart disease; however, etiology may be difficult to clarify using obstetrical ultrasound or fetal echocardiography (echo) alone. We aimed to use fetal magnetic resonance imaging (MRI) as a complementary tool to identify causes of cardiac malposition. METHODS Review of fetuses diagnosed with cardiac malposition by fetal ultrasound and echo was performed. Etiology was classified as either because of heterotaxy syndrome or extracardiac masses. Reclassification was then performed with fetal MRI findings. Results were compared with postnatal diagnoses. RESULTS Forty-two fetuses were identified as having abnormal cardiac axis and/or malposition. Twenty three of 42 cases (55%) had extracardiac anomalies, while 19 (45%) were because of heterotaxy. Twelve of 42 (29%) cases were reassigned by fetal MRI (five in heterotaxy group and seven in the lung anomaly group). Four cases (33%) had both cardiac disease and extracardiac masses, not previously recognized. Fetal MRI clarified heterotaxy subtype or removed heterotaxy diagnosis in five (26%) patients. Fetal MRI findings were confirmed in 8 of these 12 cases postnatally. CONCLUSION Fetal MRI is a useful complementary tool to define etiology of cardiac malposition in complex cases for informative prenatal counseling and planning. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lasya Gaur
- Division of Cardiology/Taussig Heart Center, Bloomberg Children's Center, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Lauren Talemal
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Dorothy Bulas
- Division of Radiology, Children's National Medical Center, Washington, DC, USA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
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Sathanandam S, Kumar TKS, Feliz A, Knott-Craig CJ. Successful Repair of Hypoplastic Left Heart Syndrome With Intact Atrial Septum, Congenital Diaphragm Hernia, and Anomalous Origin of Coronary Artery: Defying the Odds. Ann Thorac Surg 2016; 102:e55-7. [DOI: 10.1016/j.athoracsur.2015.12.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 12/16/2015] [Accepted: 12/23/2015] [Indexed: 10/21/2022]
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Ruano R, Javadian P, Kailin JA, Maskatia SA, Shamshirsaz AA, Cass DL, Zamora IJ, Sangi-Haghpeykar H, Lee TC, Ayres NA, Mehollin-Ray A, Cassady CI, Fernandes C, Welty S, Belfort MA, Olutoye OO. Congenital heart anomaly in newborns with congenital diaphragmatic hernia: a single-center experience. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:683-688. [PMID: 25158239 DOI: 10.1002/uog.14648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/31/2014] [Accepted: 08/07/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the impact of the presence of a congenital heart anomaly (CHA) and its potential contribution to morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). METHODS In this retrospective cohort study, prenatal and postnatal data of all newborns diagnosed with CDH between January 2004 and December 2012 in a single center were reviewed. Cases were classified into two groups: those with 'isolated' CDH and those with both CDH and CHA. Patients with CHA were further subclassified into those with a major or minor CHA based on the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) scoring systems. Patients with associated non-cardiac anomalies, including 'syndromic cases', were excluded from the analysis. Primary and secondary outcomes were survival up to 1 year of age and a need for extracorporeal membrane oxygenation (ECMO), respectively. RESULTS Of the 180 infants with CDH, 41 were excluded because of the presence of non-cardiac associated anomalies, 118 had isolated CDH and 21 had CDH with CHA (16 with minor and five with major CHA). Receiver-operating characteristics curve analysis demonstrated that the best cut-off for survival was when the score for CHA was ≤ 2 for both RACHS-1 (area under the curve (AUC), 0.74 (P = 0.04); sensitivity, 80.0%; specificity, 87.5%) and STS-EACTS (AUC, 0.83 (P = 0.03); sensitivity, 100%; specificity, 87.5%). Survival rate at 1 year was significantly lower in those with CHD and a major CHA (40.0%; P = 0.04) than in those with isolated CDH (77.1%) and those with CDH and a minor CHA (81.3%). We found no significant differences among the groups with regard to the need for ECMO. CONCLUSIONS In general, a milder form of CHA does not appear to have a negative impact on the survival of infants with CDH. However, mortality appears to be significantly higher in infants with CDH and a major form of CHA. The scoring systems appear to be useful as predictors for classifying the effects of CHA in this population of patients.
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Affiliation(s)
- R Ruano
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - P Javadian
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - J A Kailin
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - S A Maskatia
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - D L Cass
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - I J Zamora
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - H Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - T C Lee
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - N A Ayres
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - A Mehollin-Ray
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - C I Cassady
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - C Fernandes
- Department of Pediatrics, Division of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - S Welty
- Department of Pediatrics, Division of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
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Krebs D, Herman RS, Blewett C. Newborn male presented with congenital diaphragmatic hernia and choledochal cyst: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Acute Neonatal Respiratory Failure. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193706 DOI: 10.1007/978-3-642-01219-8_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute respiratory failure requiring assisted ventilation is one of the most common reasons for admission to the neonatal intensive care unit. Respiratory failure is the inability to maintain either normal delivery of oxygen to the tissues or normal removal of carbon dioxide from the tissues. It occurs when there is an imbalance between the respiratory workload and ventilatory strength and endurance. Definitions are somewhat arbitrary but suggested laboratory criteria for respiratory failure include two or more of the following: PaCO2 > 60 mmHg, PaO2 < 50 mmHg or O2 saturation <80 % with an FiO2 of 1.0 and pH < 7.25 (Wen et al. 2004).
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Danzer E, Hedrick HL. Controversies in the management of severe congenital diaphragmatic hernia. Semin Fetal Neonatal Med 2014; 19:376-84. [PMID: 25454678 DOI: 10.1016/j.siny.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite years of progress in perinatal care, severe congenital diaphragmatic hernia (CDH) remains a clinical challenge. Controversies include almost every facet of clinical care: the definition of severe CDH by prenatal and postnatal criteria, fetal surgical intervention, ventilator management, pulmonary hypertension management, use of extracorporeal membrane oxygenation, surgical considerations, and long-term follow-up. Breakthroughs are likely only possible by sharing of experience, collaboration between institutions and innovative therapies within well-designed multicenter clinical trials.
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Affiliation(s)
- Enrico Danzer
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
Congenital diaphragmatic hernia (CDH) is a congenital defect in the diaphragm that allows herniation of abdominal contents into the fetal chest and leads to varying degrees of pulmonary hypoplasia and pulmonary hypertension. Advances in prenatal diagnosis and the institution of standardized delivery and postnatal care protocols have led to improved survival. Fetal endoscopic tracheal occlusion shows early promise for patients with the most severe CDH, but prospective randomized data is still required. CDH survivors have a variety of associated morbidities that require long-term follow-up and early intervention strategies for optimal care.
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Affiliation(s)
- Andrea Badillo
- Children's National Medical Center, 111 Michigan Avenue NW, Suite W4-200, Washington, DC 20008.
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Takahashi S, Sago H, Kanamori Y, Hayakawa M, Okuyama H, Inamura N, Fujino Y, Usui N, Taguchi T. Prognostic factors of congenital diaphragmatic hernia accompanied by cardiovascular malformation. Pediatr Int 2013; 55:492-7. [PMID: 23565971 DOI: 10.1111/ped.12104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/06/2013] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia is associated with cardiovascular malformation. Many prognostic factors have been identified for isolated congenital diaphragmatic hernia; however, reports of concurrent congenital diaphragmatic hernia and cardiovascular malformation in infants are limited. This study evaluated congenital diaphragmatic hernia associated with cardiovascular malformation in infants. Factors associated with prognosis for patients were also identified. METHODS This retrospective cohort study was based on a Japanese survey of congenital diaphragmatic hernia patients between 2006 and 2010. Frequency and outcome of cardiovascular malformation among infants with congenital diaphragmatic hernia were examined. Severity of congenital diaphragmatic hernia and cardiovascular malformation were compared as predictors of mortality and morbidity. RESULTS Cardiovascular malformation was identified in 76 (12.3%) of 614 infants with congenital diaphragmatic hernia. Mild cardiovascular malformation was detected in 19 (33.9%) and severe cardiovascular malformation in 37 (66.1%). Their overall survival rate at discharge was 46.4%, and the survival rate without morbidity was 23.2%. Mortality and morbidity at discharge were more strongly associated with severity of cardiovascular malformation (adjusted OR 7.69, 95%CI 1.96-30.27; adjusted OR 7.93, 95%CI 1.76-35.79, respectively) than with severity of congenital diaphragmatic hernia. CONCLUSIONS The prognosis for infants with both congenital diaphragmatic hernia and cardiovascular malformation remains poor. Severity of cardiovascular malformation is a more important predictive factor for mortality and morbidity than severity of congenital diaphragmatic hernia.
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Affiliation(s)
- Shigehiro Takahashi
- Division of Neonatology, Center for Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan.
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Morini F, Valfrè L, Capolupo I, Lally KP, Lally PA, Bagolan P. Congenital diaphragmatic hernia: defect size correlates with developmental defect. J Pediatr Surg 2013; 48:1177-82. [PMID: 23845604 DOI: 10.1016/j.jpedsurg.2013.03.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/08/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of our study was to elucidate if the defect size reflects the magnitude of the developmental defect in patients with CDH. METHODS All patients recorded in the CDH Study Group registry between January 1, 2007, and December 31, 2010, and with defect classification were included in the study. They were divided according to defect size (A-D) and compared for: gestational age (GA), birth weight (BW), number of abnormal organ systems, prevalence of associated anomalies, cardiovascular malformations (CVM), chromosomal anomalies, liver in the chest, and hernia sac. RESULTS A total of 1350 of 1778 patients had defect classification: 173 A, 557 B, 438 C, and 182 D. Mortality rate was 0.6%, 5.3%, 22.6%, and 45.6% in group A, B, C, and D, respectively, (p<0.0001; p for trend <0.0001). GA, BW, prevalence of associated anomalies, particularly CVM, number of abnormal organ systems, and prevalence of sac were significantly different between the groups, with a significant reduction of GA, BW, and prevalence of sac. There was an increase in prevalence of associated anomalies, liver in the chest, and number of abnormal systems as the defect size increased. CONCLUSION Defect size is directly correlated with mortality rate, prevalence of other anomalies (particularly CVM), and number of abnormal systems, and inversely with GA, BW, and prevalence of hernia sac. The defect size may be a marker for the magnitude of developmental abnormality, thereby explaining its relationship with the outcome.
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Affiliation(s)
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- Bambino Gesù Children's Research Hospital, Rome, Italy
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Cauley RP, Stoffan A, Potanos K, Fullington N, Graham DA, Finkelstein JA, Kim HB, Wilson JM. Pulmonary support on day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia. J Pediatr Surg 2013; 48:1183-9. [PMID: 23845605 PMCID: PMC4877188 DOI: 10.1016/j.jpedsurg.2013.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/08/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE Congenital diaphragmatic hernia (CDH) is associated with significant in-hospital mortality, morbidity and length-of-stay (LOS). We hypothesized that the degree of pulmonary support on hospital day-30 may predict in-hospital mortality, LOS, and discharge oxygen needs and could be useful for risk prediction and counseling. METHODS 862 patients in the CDH Study Group registry with a LOS ≥ 30 days were analyzed (2007-2010). Pulmonary support was defined as (1) room-air (n=320) (2) noninvasive supplementation (n=244) (3) mechanical ventilation (n=279) and (4) extracorporeal membrane oxygenation (ECMO, n=19). Cox Proportional hazards and logistic regression models were used to determine the case-mix adjusted association of oxygen requirements on day-30 with mortality and oxygen requirements at discharge. RESULTS On multivariate analysis, use of ventilator (HR 5.1, p=.003) or ECMO (HR 19.6, p<.001) was a significant predictor of in-patient mortality. Need for non-invasive supplementation or ventilator on day-30 was associated with a respective 22-fold (p<.001) and 43-fold (p<.001) increased odds of oxygen use at discharge compared to those on room-air. CONCLUSIONS Pulmonary support on Day-30 is a strong predictor of length of stay, oxygen requirements at discharge and in-patient mortality and may be used as a simple prognostic indicator for family counseling, discharge planning, and identification of high-risk infants.
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Affiliation(s)
- Ryan P. Cauley
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | | | - Kristina Potanos
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Nora Fullington
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Dionne A. Graham
- Clinical Research Center, Boston Children’s Hospital, Boston, MA, USA
| | | | - Heung Bae Kim
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Jay M. Wilson
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
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Dyamenahalli U, Morris M, Rycus P, Bhutta AT, Tweddell JS, Prodhan P. Short-Term Outcome of Neonates With Congenital Heart Disease and Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2013; 95:1373-6. [DOI: 10.1016/j.athoracsur.2013.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 11/22/2012] [Accepted: 01/03/2013] [Indexed: 01/12/2023]
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Abstract
Congenital diaphragmatic hernia (CDH) is a congenital anomaly that presents with a broad spectrum of severity that is dependent upon components of pulmonary hypoplasia and pulmonary hypertension. While advances in neonatal care have improved the overall survival of CDH in experienced centers, mortality and morbidity remain high in a subset of CDH infants with severe CDH. Prenatal predictors have been refined for the past two decades and are the subject of another review in this issue. So far, all randomized trials comparing prenatal intervention to standard postnatal therapy have shown no benefit to prenatal intervention. Although recent non-randomized reports of success with fetoscopic endoluminal tracheal occlusion (FETO) and release are promising, prenatal therapy should not be widely adopted until a well-designed prospective randomized trial demonstrating efficacy is performed. The increased survival and subsequent morbidity of CDH survivors has resulted in the need to provide resources for the long-term follow up and support of the CDH population.
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Affiliation(s)
- Holly L Hedrick
- Perelman School of Medicine at the University of Pennsylvania, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Menon SC, Tani LY, Weng HY, Lally PA, Lally KP, Yoder BA. Clinical characteristics and outcomes of patients with cardiac defects and congenital diaphragmatic hernia. J Pediatr 2013; 162:114-119.e2. [PMID: 22867985 DOI: 10.1016/j.jpeds.2012.06.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 05/23/2012] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of associated heart defects on outcomes to discharge, and identify factors affecting survival of all infants born with congenital diaphragmatic hernia (CDH) in last decade using Congenital Diaphragmatic Hernia Study Group data. STUDY DESIGN This was a retrospective review of all infants with CDH enrolled in Congenital Diaphragmatic Hernia Study Group database from January 2000 to December 2010. The study cohort was divided into 3 groups (GRP): GRP 1, CDH with major heart defects; GRP 2, CDH with minor heart defects; and GRP 3, CDH with no reported heart defects. RESULTS The 4268 enrolled infants included 345 (8%) in GRP 1, 412 (10%) in GRP 2, and 3511 (82%) in GRP 3. Survival was significantly lower in GRP 1 compared with GRP 2 and GRP 3 (36% vs 73%). In GRP 1, the most common defects were left heart obstructive lesions (34%). Survival was lowest in infants with transposition of great arteries (0%) and single ventricle physiology (16%). There was no change in survival rate for any group between 2000-2005 and 2006-2010. In GRP 1, factors that predicted lower survival were birth weight <2.5 kg, associated noncardiac anomalies, single ventricle physiology, no sildenafil therapy, no CDH repair, and no cardiac repair. CONCLUSION Survival is significantly lower in patients with CDH and major heart defects compared with patients with minor or no heart defects. Outcomes of newborns with CDH and major heart defects have not improved over the last decade.
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Affiliation(s)
- Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
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Contemporary outcomes in infants with congenital heart disease and bochdalek diaphragmatic hernia. Ann Thorac Surg 2012; 95:929-34. [PMID: 22939449 DOI: 10.1016/j.athoracsur.2012.07.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/05/2012] [Accepted: 07/10/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fifteen percent of infants with congenital diaphragmatic hernia (CDH) are born with a coexisting cardiac anomaly. The purpose of this study was to evaluate contemporary outcomes in this patient population and to identify potential risk factors for in-hospital mortality. METHODS Data from all CDH neonates with congenital heart disease managed at a single pediatric tertiary care referral center between 1997 and 2011 were retrospectively analyzed. RESULTS Forty (18%) of 216 CDH patients had a cardiac anomaly. This group was associated with a significant decrease in overall survival when compared with patients without cardiac anomaly (55% versus 81%; p = 0.001). There was no association between type of cardiac anomaly and mortality based on risk stratification according to the Risk Adjustment for Congenital Heart Surgery and The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery scoring systems (p = 0.86 and p = 0.87, respectively). Birth weight was similarly no different between survivors and nonsurvivors (2.8 ± 0.6 kg versus 2.8 ± 0.9 kg, respectively; p = 0.98). There was a trend toward increased extracorporeal membrane oxygenation use among nonsurvivors (p = 0.13). Infants with hemodynamic stability enabling subsequent cardiac repair were associated with lower mortality (p = 0.04). Survivors had a wide spectrum of long-term morbidity, but most had some evidence of neurodevelopmental impairment. CONCLUSIONS This large single-institution series suggests that the overall prognosis of infants with concomitant CDH and congenital heart disease can be quite variable, regardless of the type of heart anomaly. Hemodynamic instability and need for extracorporeal membrane oxygenation correlate with higher mortality. Although some long-term survivors have excellent outcomes, most suffer from chronic, long-term morbidities.
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Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high-risk patients with congenital diaphragmatic hernia? J Pediatr Surg 2012; 47:1053-7. [PMID: 22703768 DOI: 10.1016/j.jpedsurg.2012.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/05/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE In the most severe cases of congenital diaphragmatic hernia (CDH), significant barotrauma or death can occur before advanced therapies such as extracorporeal membrane oxygenation (ECMO) can be initiated. We have previously examined the use of the ex utero intrapartum treatment (EXIT) to ECMO procedure (EXIT with placement on ECMO) in high-risk infants and reported a survival advantage. We report our experience with EXIT to ECMO in a more recent cohort of our patients with most severe CDH. METHODS Every patient with less than 15% predicted lung volume during January 2005 to December 2010 was included. We obtained data on prenatal imaging, size and location of the defect, and survival. RESULTS Seventeen high-risk infants were identified. All 17 (100%) received ECMO and required a patch. Six children were delivered by EXIT to ECMO, and only 2 (33%) survived. An additional patient was delivered by EXIT to intubation with ECMO on standby and died. Of the 10 children who did not receive EXIT, 5 (50%) survived. CONCLUSIONS No clear survival benefit with the use of the EXIT to ECMO procedure was demonstrated in this updated report of our high-risk CDH population. The general application of EXIT to ECMO for CDH is not supported by our results.
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Tetralogy of Fallot with congenital diaphragmatic hernia and left lung hypoplasia: assessment of the adequacy of the peripheral pulmonary vascular growth after hernia repair. Cardiol Young 2012; 22:235-8. [PMID: 21920056 DOI: 10.1017/s104795111100134x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Congenital diaphragmatic hernia is a life-threatening condition frequently associated with various congenital cardiac diseases. In congenital diaphragmatic hernia associated with tetralogy of Fallot, central pulmonary artery size of the affected side may not reflect the capacitance of peripheral pulmonary vascular beds. We report a case of congenital diaphragmatic hernia associated with tetralogy of Fallot, which was repaired after assessing the adequacy of the pulmonary vascular beds by intra-operative pulmonary blood flow study.
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Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW. Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: practice guidelines and recommendations for training. Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). J Am Soc Echocardiogr 2012; 24:1057-78. [PMID: 21933743 DOI: 10.1016/j.echo.2011.07.014] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Luc Mertens
- The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
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Pennaforte T, Rakza T, Sfeir R, Aubry E, Bonnevalle M, Fayoux P, Deschildre A, Thumerelle C, de Lagausie P, Benachi A, Storme L. [Congenital diaphragmatic hernia: respiratory and vascular outcomes]. Rev Mal Respir 2012; 29:337-46. [PMID: 22405123 DOI: 10.1016/j.rmr.2011.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 07/12/2011] [Indexed: 11/17/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly associated with a variable degree of pulmonary hypoplasia (PH) and persistent pulmonary hypertension (PPH). Despite remarkable advances in neonatal resuscitation and intensive care, and new postnatal treatment strategies, the rates of mortality and morbidity in the newborn with CDH remain high as the result of severe respiratory failure secondary to PH and PPH. Later, lung function assessments show obstructive and restrictive impairments due to altered lung structure and lung damage due to prolonged ventilatory support. The long-term consequences of pulmonary hypertension are unknown. Other problems include chronic pulmonary aspiration caused by gastro-oesophageal reflux and respiratory manifestations of allergy such as asthma or rhinitis. Finally, failure to thrive may be caused by increased caloric requirements due to pulmonary morbidity. Follow-up studies that systematically assess long-term sequelae are needed. Based on such studies, a more focused approach for routine multidisciplinary follow-up programs could be established. It is the goal of the French Collaborative Network to promote exchange of knowledge, future research and development of treatment protocols.
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Affiliation(s)
- T Pennaforte
- Pôle de médecine périnatale, site de Lille, hôpital Jeanne-de-Flandre, CHRU de Lille, 1 rue Eugène-Avinée, Lille cedex, France.
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Le LD, Keswani SG, Biesiada J, Lim FY, Kingma PS, Haberman BE, Frischer J, Habli M, Crombleholme TM. The congenital diaphragmatic hernia composite prognostic index correlates with survival in left-sided congenital diaphragmatic hernia. J Pediatr Surg 2012; 47:57-62. [PMID: 22244393 PMCID: PMC3870853 DOI: 10.1016/j.jpedsurg.2011.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/06/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE We developed the congenital diaphragmatic hernia congenital prognostic index (CDH-CPI) to incorporate all known prognostic variables into a single composite index to improve prognostic accuracy. The purpose of this study is to examine the ability of the CDH-CPI to predict survival in patients with left-sided congenital diaphragmatic hernia and to determine if the index has a stronger correlation with survival than each of the individual components. METHODS A retrospective review of patients with left-sided congenital diaphragmatic hernia between 2004 and 2010 was conducted. Ten prenatal parameters of the CDH-CPI were collected, total score was tabulated, and patients stratified according to total score and survival. RESULTS Sixty-four patients with a prenatal diagnosis of left-sided congenital diaphragmatic hernia were identified. Patients with a CDH-CPI score of 8 or higher had a significantly higher survival than patients with a CDH-CPI score of lower than 8. The CDH-CPI has the strongest correlation with survival compared with the individual parameters measured. The CDH-CPI correlates with extracorporeal membrane oxygenation use, and 75% of patients with a score of 5 or lower were placed on extracorporeal membrane oxygenation. CONCLUSIONS The CDH-CPI accurately stratifies survival in left-sided congenital diaphragmatic hernia. The amalgamation of 10 prenatal parameters of the CDH-CPI may be a better prenatal predictor than any single prognostic variable currently used.
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Affiliation(s)
- Louis D. Le
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Sundeep G. Keswani
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Jacek Biesiada
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Foong-Yen Lim
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Paul S. Kingma
- Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - Beth E. Haberman
- Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - Jason Frischer
- Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Mounira Habli
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Timothy M. Crombleholme
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Colorado Fetal Care Center, Colorado Institute for Maternal Fetal Health, Children’s Hospital, Colorado and the University of Colorado School of Medicine, Aurora, CO 80045, USA,Corresponding author. Division of General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, MLC 11025 Cincinnati, Ohio 45229-3039, USA. Tel.: +1 513 636 6259; fax: +1 513 636 2735. (T.M. Crombleholme)
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46
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Van Mieghem T, Cruz-Martinez R, Allegaert K, Dekoninck P, Castanon M, Sandaite I, Claus F, Devlieger R, Gratacos E, Deprest J. Outcome of fetuses with congenital diaphragmatic hernia and associated intrafetal fluid effusions managed in the era of fetal surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:50-55. [PMID: 21910146 DOI: 10.1002/uog.10097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions. METHODS This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions. RESULTS The incidence of effusions was 5.2% (n = 14) in 269 consecutive cases of left-sided CDH and 29.2% (n = 14) in 48 cases of right-sided CDH. Hydrothorax (n = 19 (68%)) and ascites (n = 16 (57%)) were the most common effusions. A combination of both was present in 11 (39%) fetuses. Of 20 ongoing pregnancies with CDH and fluid effusions, without other anomalies, five with moderate or mild pulmonary hypoplasia were managed without fetoscopic endoluminal tracheal occlusion (FETO). The 15 other cases underwent FETO because of severe pulmonary hypoplasia. Neonatal survival rate was similar in both groups (n = 2/5 and n = 6/15, respectively (P = 1.0)). Survival among those who underwent FETO was similar to previously published results concerning isolated cases undergoing FETO. CONCLUSIONS Our observations do not support the view that intrafetal effusions are an adverse prognostic factor in fetuses with CDH. In CDH fetuses with effusions and severe pulmonary hypoplasia treated with FETO, neonatal survival is similar to that in isolated cases undergoing the intervention. Whether pleural effusions should be addressed by thoracic drainage procedures remains unproven.
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Affiliation(s)
- T Van Mieghem
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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47
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Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW. Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: Practice Guidelines and Recommendations for Training: Writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:715-36. [PMID: 21998460 DOI: 10.1093/ejechocard/jer181] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Luc Mertens
- The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
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48
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Abstract
The field of neonatal surgery is now inextricably linked to the field of obstetrics. Neonatologists and surgical specialists experienced with the postnatal management and outcomes of infants with various disorders now look in utero along with obstetricians and fetal medicine specialists to characterize the development and well-being of fetuses with congenital anomalies with a goal to optimize fetal, perinatal and postnatal management. The purpose of this article is to examine how prenatal diagnosis and therapy has influenced neonatal surgery. An overview of prenatal diagnosis and the evolution of fetal therapy are provided. In addition, we review the impact of prenatal diagnosis and therapy on the management and outcomes of infants with specific anomalies, including congenital lung malformations, sacrococcygeal teratoma, myelomeningocele, giant fetal neck masses, diaphragmatic hernia and congenital heart defects.
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Affiliation(s)
- Darrell L Cass
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
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49
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Hedrick HL. Management of prenatally diagnosed congenital diaphragmatic hernia. Semin Fetal Neonatal Med 2010; 15:21-7. [PMID: 19884051 DOI: 10.1016/j.siny.2009.07.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a congenital anomaly that presents with a broad spectrum of severity dependent upon components of pulmonary hypoplasia and pulmonary hypertension. While advances in neonatal care have improved the overall survival of CDH in experienced centers, mortality and morbidity remain high in a subset of CDH infants with severe CDH. The most important prenatal predictor of outcome in left-sided CDH is liver position. More precise and reproducible prenatal predictive parameters need to be developed to allow standardization of results between centers and appropriate design of clinical trials in CDH. Thus far, all randomized trials comparing prenatal intervention to standard postnatal therapy have shown no benefit to prenatal intervention. Although recent non-randomized reports of success with balloon tracheal occlusion (and release) are promising, prenatal therapy should not be widely adopted until a well-designed prospective randomized trial demonstrating efficacy is performed. The increased survival and subsequent morbidity of CDH survivors has resulted in the need to provide resources for the long-term follow-up and support of the CDH population.
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Affiliation(s)
- Holly L Hedrick
- University of Pennsylvania, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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50
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Bell A, Beerbaum P, Greil G, Hegde S, Toschke AM, Schaeffter T, Razavi R. Noninvasive Assessment of Pulmonary Artery Flow and Resistance by Cardiac Magnetic Resonance in Congenital Heart Diseases With Unrestricted Left-to-Right Shunt. JACC Cardiovasc Imaging 2009; 2:1285-91. [DOI: 10.1016/j.jcmg.2009.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 07/23/2009] [Accepted: 07/28/2009] [Indexed: 11/25/2022]
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