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Goldshore M, Land S, Flohr S, Mathew L, Reynolds T, Eppley E, Rintoul N, Gebb J, Howell L, Adzick NS, Hedrick H. The Impact of Comprehensive Fetal Care on Mortality of Children With Congenital Diaphragmatic Hernia when Delivery is Co-located in a Pediatric Hospital. J Pediatr Surg 2024; 59:445-450. [PMID: 37914590 DOI: 10.1016/j.jpedsurg.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND We evaluated the impact of delivery at a comprehensive fetal care center co-located in a pediatric hospital on extracorporeal membrane oxygenation (ECMO) exposure and survivorship of children with CDH. METHODS This retrospective study includes maternal-fetal dyads with a prenatal diagnosis of isolated CDH who received any prenatal care at a single fetal center between February 2006 and March 2021. The principal variables included: (1) delivery setting (children born in the pediatric hospital ["inborn"] vs. children who were delivered elsewhere ["outborn"]), (2) exposure to ECMO (yes vs. no), and (3) survival-at-discharge from birth hospitalization (yes vs. no). Multivariable logistic regression was used to evaluate the association between delivery setting and ECMO cannulation, and whether delivery setting moderates the association between exposure to ECMO and survival-at-discharge. RESULTS Among 418 maternal-fetal dyads, 77.0% of children were inborn and 32.0% of children were exposed to ECMO during their index hospitalization. Inborn children had more severe prenatal prognostic indicators but had a 57% lower odds of extracorporeal than outborn children. In multivariable logistic regression, delivery setting moderated the association between exposure to ECMO and survival-at-discharge. Although there was no statistically significant difference in mortality between inborn and outborn children who were not exposed to ECMO, inborn children exposed to ECMO had a 6.86 (1.98, 23.74) increased odds of death and outborn children exposed to ECMO had a 17.71 (4.69, 66.87) increased odds of death when both were compared to non-cannulated outborn children. CONCLUSIONS Comprehensive fetal care with delivery co-located in a pediatric hospital was associated with decreased exposure to ECMO and a survivorship advantage among children with CDH who required extracorporeal support. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthew Goldshore
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Sierra Land
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Sabrina Flohr
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Leny Mathew
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tom Reynolds
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Elizabeth Eppley
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Natalie Rintoul
- Division of Neonatology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana Gebb
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori Howell
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly Hedrick
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Dassios T, Williams EE, Kaltsogianni O, Greenough A. Permissive hypercapnia and oxygenation impairment in premature ventilated infants. Respir Physiol Neurobiol 2023; 317:104144. [PMID: 37647975 DOI: 10.1016/j.resp.2023.104144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/04/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023]
Abstract
AIM In permissive hypercapnia high levels of carbon dioxide (CO2) are tolerated in ventilated preterm infants to minimise lung injury, but hypercapnia could directly impair oxygenation. We aimed to quantify the association of elevated CO2 with oxygenation impairment in preterm infants by measuring the right-to-left shunt and the ventilation/perfusion (VA/Q) ratio. METHODS Pre-existing datasets from preterm infants during the acute phase of respiratory distress syndrome or with evolving or established bronchopulmonary dysplasia were analysed. Non-invasive paired measurements of the fraction of inspired oxygen (FIO2) and transcutaneous oxygen saturation (SpO2) were used to calculate the degree of right-to-left shunt, right shift of the FIO2 versus SpO2 curve and the VA/Q. RESULTS A total of 75 infants (43 male) with a median (IQR) gestational age of 26.4 (24.7-27.7) weeks were studied at 7 (2-31) days. Thirty-six infants (48 %) had an arterial partial pressure of CO2 (PaCO2) above 6 kPa. The PaCO2 was independently associated with the right shift of the curve [adjusted p < 0.001, unstandardised coefficient; 2.26, 95 % CI: 1.51-2.95] and the right-to-left shunt [adjusted p = 0.016, unstandardised coefficient; 1.86, 95 % CI: 0.36-3.36] after adjusting for confounders. An increase of the PaCO2 from 5 to 8 kPa, corresponded to a right shift of the curve of 20.2 kPa or a decrease in the VA/Q from 0.66 to 0.24. CONCLUSIONS Increased carbon dioxide levels were significantly associated with impaired oxygenation in preterm infants with respiratory distress syndrome or bronchopulmonary dysplasia.
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Affiliation(s)
- Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; Neonatal Intensive Care Unit, University of Patras, Patras, Greece.
| | - Emma E Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Ourania Kaltsogianni
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
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Carbon dioxide levels in neonates: what are safe parameters? Pediatr Res 2022; 91:1049-1056. [PMID: 34230621 PMCID: PMC9122818 DOI: 10.1038/s41390-021-01473-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/01/2023]
Abstract
There is no consensus on the optimal pCO2 levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO2 ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO2 levels that were found to increase the risk of neonatal disease. Although PaCO2 ranges were reported from 2.6 to 8.7 kPa (19.5-64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO2 6.0-7.3 kPa: 45.0-54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO2 ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO2 parameters and correlation with outcomes. IMPACT: There is no consensus on the optimal pCO2 levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO2 of 5-7 kPa was inferred following systematic review.
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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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Abstract
Prenatal diagnosis has changed perinatal medicine dramatically, allowing for additional fetal monitoring, referral and counseling, delivery planning, the option of fetal intervention, and targeted postnatal management. Teams participating in the delivery room care of infants with known anomalies should be knowledgeable about specific needs and expectations but also ready for unexpected complications. A small number of neonates will need rapid access to postnatal interventions, such as surgery, but most can be stabilized with appropriate neonatal care. These targeted perinatal interventions have been shown to improve outcome in selected diagnoses.
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Affiliation(s)
- Elizabeth K Sewell
- Emory Children's Center Neonatalogy Offices, 2015 Uppergate Drive-3(rd) floor, Atlanta, GA 30322, USA
| | - Sarah Keene
- Emory Children's Center Neonatalogy Offices, 2015 Uppergate Drive-3(rd) floor, Atlanta, GA 30322, USA.
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Baxter KJ, Gale BF, Travers CD, Heiss KF, Raval MV. Ramifications of the Children's Surgery Verification Program for Patients and Hospitals. J Am Coll Surg 2018; 226:917-924.e1. [DOI: 10.1016/j.jamcollsurg.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
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Bojanić K, Grizelj R, Vuković J, Omerza L, Grubić M, Ćaleta T, Weingarten TN, Schroeder DR, Sprung J. Health-related quality of life in children and adolescents with congenital diaphragmatic hernia: a cross-sectional study. Health Qual Life Outcomes 2018. [PMID: 29540236 PMCID: PMC5853065 DOI: 10.1186/s12955-018-0869-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with congenital diaphragmatic hernia (CDH) have a high residual morbidity rate. We compared self-reported health-related quality of life (HRQoL) between patients with CDH and healthy children. METHODS Forty-five patients with CDH who were born from January 1, 1990, through February 15, 2015, were matched to healthy, age-matched control participants at a 1:2 ratio. The health records of the study participants were reviewed to determine comorbid conditions, and HRQoL was assessed by both the participants and their parents with the Pediatric Quality of Life Inventory (PedsQL). The HRQoL scores of the patients with CDH and the control participants were compared by using analysis of variance to adjust for age group and sex. Among patients with CDH, analysis of variance was used to compare HRQoL scores across groups defined according to their characteristics at initial hospitalization, postdischarge events, and comorbid conditions. RESULTS Compared with control participants, patients with CDH had lower mean PedsQL scores, as reported by the parent and child, for the physical and psychosocial domains (P < 0.001). Risk factors associated with lower parent-reported HRQoL included bronchopulmonary dysplasia, longer initial hospitalization, severe cognitive impairment, and orthopedic symptoms; among patients with CDH, low HRQoL was associated with chronic respiratory issues. CONCLUSION Patients with CDH had lower HRQoL compared with healthy participants. Parent-reported HRQoL tended to be higher than child-reported HRQoL. Results were also inconsistent for the risk factors associated with HRQoL obtained by using child- and parent-reported scores. Therefore, when interpreting HRQoL in CDH survivors, a proxy report should not be considered a substitute for a child's self-report.
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Affiliation(s)
- Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Ruža Grizelj
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre, Zagreb, Croatia
| | - Jurica Vuković
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre, Zagreb, Croatia
| | - Lana Omerza
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre, Zagreb, Croatia
| | - Marina Grubić
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre, Zagreb, Croatia
| | - Tomislav Ćaleta
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre, Zagreb, Croatia
| | - Toby N Weingarten
- Division of Multispecialty Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Juraj Sprung
- Division of Multispecialty Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Woodbury JM, Bojanić K, Grizelj R, Cavalcante AN, Donempudi VK, Weingarten TN, Schroeder DR, Sprung J. Incidence of congenital diaphragmatic hernia in Olmsted County, Minnesota: a population-based study. J Matern Fetal Neonatal Med 2017; 32:742-748. [PMID: 28992719 DOI: 10.1080/14767058.2017.1390739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The rate of congenital diaphragmatic hernia (CDH) varies, but most reports estimate the incidence to be less than three per 10,000 births. Our objective was to document the incidence of CDH in a geographically well-defined population using available resources for highly accurate incident case ascertainment. METHODS We ascertained CDH cases in Olmsted County, Minnesota, United States of America, from 1981 through 2014 using resources of the Rochester Epidemiology Project. Overall and sex-specific incidence rates were calculated, and hospital survival was assessed. RESULTS A total of 26 incident CDH cases were identified; the overall incidence of 3.6 (95% CI, 2.2-5.0) per 10,000 did not differ significantly over the 34-year study period (p = .28). The estimated incidence was 4.3 (95% CI, 2.2-6.5) for male infants and 2.9 (95% CI, 1.1-4.6) for female infants. The percentage of cases diagnosed prenatally was 33% from 1981 through 2000 and 50% from 2001 through 2014. The rate of survival to discharge in the two periods was 50% and 88%. CONCLUSION The incidence of CDH in Olmsted County exceeds the majority of published rates, which most likely can be attributed to our comprehensive case ascertainment.
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Affiliation(s)
- Jason M Woodbury
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Katarina Bojanić
- b Division of Neonatology, Department of Obstetrics and Gynecology , University Hospital Merkur , Zagreb , Croatia
| | - Ruža Grizelj
- c Department of Pediatrics , University of Zagreb, School of Medicine, University Hospital Centre Zagreb , Zagreb , Croatia
| | - Alexandre N Cavalcante
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Vinay K Donempudi
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Toby N Weingarten
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Darrell R Schroeder
- d Division of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , MN , USA
| | - Juraj Sprung
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
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Morgan TA, Basta A, Filly RA. Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach-down left congenital diaphragmatic hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:8-13. [PMID: 27663268 DOI: 10.1002/jcu.22400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/21/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of this study was to identify sonographic (US) findings that can assist in prenatal diagnosis of stomach-down left congenital diaphragmatic hernia (CDH), specifically related to positioning of the abdominal contents including the stomach, bladder, and gallbladder. METHODS All US examinations with a postnatally confirmed diagnosis of stomach-down left CDH over a 13-year period were retrospectively reviewed for abnormal position of the abdominal contents, including whether the fetal stomach was in contact with the urinary bladder. Normal fetuses that underwent comprehensive US surveys were similarly evaluated for comparison in a 2:1 ratio. RESULTS Twenty-two fetuses with stomach-down left CDH were identified in a cohort of 278 fetuses with left CDH. In 15/22 (68.2%) cases of stomach-down left CDH, the bladder and stomach walls were in contact. Contact of the fetal gallbladder with the fetal bladder wall was also observed and was present even more commonly (17/22 cases [77.3%]). There was no case of either the stomach or gallbladder in contact with the bladder wall in the normal fetal cohort (n = 44). CONCLUSIONS Recognition of the fetal stomach and/or gallbladder in contact with the bladder wall can help in the detection of stomach-down left CDH. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:8-13, 2017.
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Affiliation(s)
- Tara A Morgan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, L374, 505 Parnassus Avenue, San Francisco, CA, 94143-0628
| | - Amaya Basta
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR
| | - Roy A Filly
- Department of Radiology and Biomedical Imaging, University of California San Francisco, L374, 505 Parnassus Avenue, San Francisco, CA, 94143-0628
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Bojanić K, Grizelj R, Dilber D, Šarić D, Vuković J, Pianosi PT, Driscoll DJ, Weingarten TN, Pritišanac E, Schroeder DR, Sprung J. Cardiopulmonary exercise performance is reduced in congenital diaphragmatic hernia survivors. Pediatr Pulmonol 2016; 51:1320-1329. [PMID: 27228382 DOI: 10.1002/ppul.23481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia. CDH survivors may have pulmonary morbidity that can decrease cardiopulmonary exercise. We aimed to examine whether cardiopulmonary exercise testing (CPET) results differ in CDH survivors versus healthy age-matched controls and whether CPET results among CDH survivors differ according to self-reported daily activity. METHODS In one medical center in Croatia, CDH survivors-patients with surgically corrected CDH who were alive at age 5 years-were invited to participate in spirometry and CPET. Values were compared with those of controls matched 2:1 by age and sex for each CDH survivor aged 7 years or older. RESULTS Among 27 CDH survivors aged 5-20 years, 13 (48%) had continued symptoms or spirometric evidence of pulmonary disease. Compared with controls (n = 44), survivors (n = 22) had lower peak oxygen consumption (V˙O2 mean [SD], 35.7 [6.9] vs. 45.3 [8.2] ml/kg per min; P < 0.001). At peak exercise, V˙O2/heart rate (P < 0.001), tidal volume (P = 0.005), and minute ventilation (P < 0.001) were lower in survivors, but the maximal respiratory rate was not different (P = 0.72). Among survivors, mean (SD) V˙O2peak (ml/kg per min) differed by self-reported activity level: athletic, 40.3 (5.0); normal, 35.8 (6.5); and sedentary, 32.1 (6.8) (by ANOVA, P = 0.10 across three groups and P = 0.04 athletic vs. sedentary). CONCLUSION More than half of CDH survivors continue to have chronic pulmonary disease. CDH survivors had lower aerobic exercise capacity than controls. Self-reporting information on daily activities may identify CDH patients with low V˙O2max who may benefit from physical training. Pediatr Pulmonol. 2016;51:1320-1329. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Ruža Grizelj
- Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Daniel Dilber
- Division of Pediatric Cardiology, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Dalibor Šarić
- Division of Pediatric Cardiology, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Jurica Vuković
- Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Paolo T Pianosi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - David J Driscoll
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester 55905, Minnesota
| | - Ena Pritišanac
- Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester 55905, Minnesota
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Bojanić K, Grubić M, Bogdanić A, Vuković J, Weingarten TN, Huebner AR, Sprung J, Schroeder DR, Grizelj R. Neurocognitive outcomes in congenital diaphragmatic hernia survivors: a cross-sectional prospective study. J Pediatr Surg 2016; 51:1627-34. [PMID: 27519557 DOI: 10.1016/j.jpedsurg.2016.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND/PURPOSE Congenital diaphragmatic hernia (CDH) survivors may have persistent neurocognitive delays. We assessed neurodevelopmental outcomes in CDH survivors from infancy to late teenage years. METHODS A cross-sectional study was conducted on 37 CDH survivors to examine neurocognitive functioning. Overall cognitive score was tested with the early learning composite (ELC) of Mullen Scales of Early Learning (n=19), and Full Scale IQ (FSIQ) of Wechsler Intelligence Scale for Children-Fourth Edition (n=18). RESULTS ELC was 85.7±16.4, lower than the expected norm of 100, P=0.004, and 6 survivors had moderate, and 3 severe delay, which is not greater than expected in the general population (P=0.148). FSIQ was 99.6±19.1, consistent with the expected norm of 100, P=0.922, and 3 survivors had moderate and 2 severe delay, which is greater than expected (P=0.048). Although ELC was lower than FSIQ (P=0.024), within each testing group overall cognitive ability was not associated with participant age (ELC, P=0.732; FSIQ, P=0.909). Longer hospital stay was the only factor found to be consistently associated with a worse cognitive score across all participants in our cohort. CONCLUSIONS A high percentage of survivors with CDH have moderate to severe cognitive impairment suggesting that these subjects warrant early testing with implementation of therapeutic and educational interventions.
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Affiliation(s)
- Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Marina Grubić
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Croatia
| | - Ana Bogdanić
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Croatia
| | - Jurica Vuković
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Croatia
| | | | - Andrea R Huebner
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Darrell R Schroeder
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Ruža Grizelj
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Croatia
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Grizelj R, Bojanić K, Pritišanac E, Luetić T, Vuković J, Weingarten TN, Schroeder DR, Sprung J. Survival prediction of high-risk outborn neonates with congenital diaphragmatic hernia from capillary blood gases. BMC Pediatr 2016; 16:114. [PMID: 27473834 PMCID: PMC4966580 DOI: 10.1186/s12887-016-0658-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The extent of lung hypoplasia in neonates with congenital diaphragmatic hernia (CDH) can be assessed from gas exchange. We examined the role of preductal capillary blood gases in prognosticating outcome in patients with CDH. METHODS We retrospectively reviewed demographic data, disease characteristics, and preductal capillary blood gases on admission and within 24 h following admission for 44 high-risk outborn neonates. All neonates were intubated after delivery due to acute respiratory distress, and were emergently transferred via ground ambulance to our unit between 1/2000 and 12/2014. The main outcome measure was survival to hospital discharge and explanatory variables of interest were preductal capillary blood gases obtained on admission and during the first 24 h following admission. RESULTS Higher ratio of preductal partial pressure of oxygen to fraction of inspired oxygen (PcO2/FIO2) on admission predicted survival (AUC = 0.69, P = 0.04). However, some neonates substantially improve PcO2/FIO2 following initiation of treatment. Among neonates who survived at least 24 h, the highest preductal PcO2/FIO2 achieved in the initial 24 h was the strongest predictor of survival (AUC = 0.87, P = 0.002). Nonsurvivors had a mean admission preductal PcCO2 higher than survivors (91 ± 31 vs. 70 ± 25 mmHg, P = 0.02), and their PcCO2 remained high during the first 24 h of treatment. CONCLUSION The inability to achieve adequate gas exchange within 24 h of initiation of intensive care treatment is an ominous sign in high-risk outborn neonates with CDH. We suggest that improvement of oxygenation during the first 24 h, along with other relevant clinical signs, should be used when making decisions regarding treatment options in these critically ill neonates.
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Affiliation(s)
- Ruža Grizelj
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Katarina Bojanić
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Ena Pritišanac
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tomislav Luetić
- Department of Pediatric Surgery, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jurica Vuković
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Grizelj R, Bojanić K, Vuković J, Novak M, Rodin U, Ćorić T, Stanojević M, Schroeder DR, Weingarten TN, Sprung J. Epidemiology and Outcomes of Congenital Diaphragmatic Hernia in Croatia: A Population-Based Study. Paediatr Perinat Epidemiol 2016; 30:336-45. [PMID: 27016030 DOI: 10.1111/ppe.12289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres-a possible source of bias. Population-based studies decrease survivor bias and provide additional insight into this high-mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia. METHODS All cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex- and region-specific incidence rates were calculated, and characteristics associated with 1-year survival were assessed. RESULTS We identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1-year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1). CONCLUSIONS The incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia.
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Affiliation(s)
- Ruža Grizelj
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Jurica Vuković
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Milivoj Novak
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Urelija Rodin
- School of Public Health "A. Štampar" and Croatian Institute of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tanja Ćorić
- School of Public Health "A. Štampar" and Croatian Institute of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital Sveti Duh, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
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