Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus

Shinno, Yoshitaka; Terui, Keita; Endo, Morito; Saito, Takeshi; Nakata, M.; Komatsu, Shojiro; Oita, Satoru; Katsumata, Yoshio; Saeda, Yukiko; Ozeki, Genta; Ohsone, Yoshiteru; Hishiki, Tomoro

doi:10.1007/s00383-020-04788-9

Cited by 8 publications

(9 citation statements)

References 20 publications

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“…However, these markers did not predict the occurrence of PH in a recent systematic review ( 18 ). In addition, PH has been discussed as an important guiding parameter in the timing of the surgical repair ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Dynamics of pulmonary hypertension severity in the first 48 h in neonates with prenatally diagnosed congenital diaphragmatic hernia

et al. 2023

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IntroductionPulmonary hypertension (PH) is one of the major contributing factors to the high morbidity and mortality in neonates with congenital diaphragmatic hernia (CDH). The severity and duration of postnatal PH are an established risk factor for patient outcome; however, the early postnatal dynamics of PH have not been investigated. This study aims to describe the early course of PH in CDH infants, and its relation to established prognostic markers and outcome measures.MethodsWe performed a monocentric retrospective review of neonates with prenatally diagnosed CDH, who received three standardized echocardiographic examinations at 2–6 h, 24, and 48 h of life. The degree of PH was graded as one of three categories: mild/no, moderate, or severe PH. The characteristics of the three groups and their course of PH over 48 h were compared using univariate and correlational analyses.ResultsOf 165 eligible CDH cases, initial PH classification was mild/no in 28%, moderate in 35%, and severe PH in 37%. The course of PH varied markedly based on the initial staging. No patient with initial no/mild PH developed severe PH, required extracorporeal membrane oxygenation (ECMO)-therapy, or died. Of cases with initial severe PH, 63% had persistent PH at 48 h, 69% required ECMO, and 54% died. Risk factors for any PH included younger gestational age, intrathoracic liver herniation, prenatal fetoscopic endoluminal tracheal occlusion (FETO)-intervention, lower lung to head ratio (LHR), and total fetal lung volume (TFLV). Patients with moderate and severe PH showed similar characteristics, except liver position at 24- (p = 0.042) and 48 h (p = 0.001), mortality (p = 0.001), and ECMO-rate (p = 0.035).DiscussionTo our knowledge, this is the first study to systematically assess the dynamics of PH in the first postnatal 48 h at three defined time points. CDH infants with initial moderate and severe PH have a high variation in postnatal PH severity over the first 48 h of life. Patients with mild/no PH have less change in PH severity, and an excellent prognosis. Patients with severe PH at any point have a significantly higher risk for ECMO and mortality. Assessing PH within 2–6 h should be a primary goal in the care for CDH neonates.

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Section: Discussionmentioning

confidence: 99%

Dynamics of pulmonary hypertension severity in the first 48 h in neonates with prenatally diagnosed congenital diaphragmatic hernia

et al. 2023

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“…24 PDA blood ow patterns can act as reliable indicators of neonatal PH for optimal CDH repair timing, with the best intervention period being when PDA blood ow shifts to a left-to-right shunt. 25 This case re ects such an approach, determining surgery timing based on continuous echocardiographic monitoring of pulmonary artery pressure and PDA blood ow patterns under iNO or sildena l treatment. This case also illustrates that pre-ECMO cannulation surgery can promptly restore normal anatomy, alleviate thoracic compression, and create space for lung expansion.…”

Section: Case Presentationmentioning

confidence: 98%

Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Hong,

Zheng,

Zheng

et al. 2024

Preprint

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Background: Therapeutic measures regarding combined extracorporeal membrane oxygenation support and arterial ductus arteriosus ligation after surgical correction of congenital diaphragmatic hernia are rare in clinical practice. Case presentation: In this case, the patient was diagnosed at 24 weeks with a right-sided diaphragmatic hernia. He was the firstborn, delivered at 37 weeks via cesarean section due to fetal distress. Due to severe hypoxemia and pulmonary hypertension, the patient underwent right-sided thoracic diaphragmatic hernia repair surgery at 22 hours post-birth. Perioperatively, the patient exhibited severe respiratory and circulatory failure. Consequently, ECMO support was initiated one hour after the surgery (24 hours post-birth). Due to the high left to right shunt, bedside patent arterial duct ligation was successfully performed under ECMO support four hours later (28 hours post-birth). During the second day on ECMO, the patient developed intracranial hemorrhage, leading to the performance of a lateral ventriculostomy. Fortunately, the patient was successfully weaned off ECMO. Conclusions: Treatment strategies for CDH must be tailored to each patient’s unique clinical situation, encompassing aspects such as ventilation tactics, surgical timing, anesthesia choices, and surgical techniques. The detailed analysis of this case in this report illustrates the critical importance of tailoring CDH management to optimize patient prognosis.

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“…Advances in medical therapies during the past decade(s) have steadily improved CDH mortality. However, high mortality rates are observed during the rst days to weeks of life due to aggravation of CDH-PH following birth [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…A study from the UK in 2012 showed the best OI on day 1 of life as a strong predictor of survival in CDH [9]. Because PH is altered by (i) various kinds of stressors (ii) pulmonary compliance mechanics (iii) active ventilator management and (iv) cardiopulmonary stabilisation strategy -a single best OI may not be representative of overall lung function [4,7,10]. Tan et al [7] proposed that a serial OI measured during the rst 24hours of life may potentially better guide early CDH management as well as setting realistic expectations of a newborns subsequent response to intensive care therapy(s).…”

Section: Introductionmentioning

confidence: 99%

Utility of the Oxygenation Index in Management of Congenital Diaphragmatic Hernia – a Report From a Thai University Surgical Centre

Kulngamnetr,

Pongmee,

Losty

et al. 2024

Preprint

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Background : Oxygenation index (OI) is associated with severity of newborn pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH). Higher OI may indicate worst degree(s) of PH. Objectives : This study reports OI dynamic(s) over the first 72 hours of life and its correlation with (i) perioperative morbidity and (ii) CDH mortality. Methods: Medical records of inborn CDH babies during 2002-2022 were examined. OI on Days (s) 1-3 and perioperative OI trends were recorded. Operation (primary vs patch repair) and survival rates (%) were studied. Results: 55 CDH newborns (54.5% male : 45.5% female) - mean birth GA 37.5±2.7 wks. had a mean birth weight 2813 ±684 g with prenatal diagnosis in 32.7% cases. 52/55 (94.5%) were intubated at birth and HFOV deployed in 29 (55.8%). Those requiring HFOV had higher OI on DOL1 (24.8± 17 vs 10.3±11.5; p< 0.05), DOL 2 (26.3± 22.9 vs 6.7±12.1; p < 0.05) and DOL 3 (21.9± 33.8 vs 5.5±9.3; p =0.04). Operation was undertaken in 36/55 (65.5%). Preoperative mortality group had significant higher OI on DOL 2 (42.1 ±21.0 vs 14.9±9.3; p =0.04). CDH defects were - Type A N=27 (75%), Type B N=7 (19.4%) and Type C N= 2 (5.6%). Overall mortality was 40% (22/55). Statistically significant OI trends were recorded in Non-Survival vs. Survival Groups on DOL 1 (31.6 ±16.8. vs 10.5±9.0; p <0.05, DOL 2 (38.1 ±21.9 vs 6.3±7.1; p <0.05), and DOL 3 (38.8 ±39.4; p=0.012) Conclusions: OI dynamics are highly predictive for accurate monitoring of CDH cardiorespiratory physiology and crucially may guide ventilatory management as well as timing of surgery.

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Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus

Cited by 8 publications

References 20 publications

Dynamics of pulmonary hypertension severity in the first 48 h in neonates with prenatally diagnosed congenital diaphragmatic hernia

Dynamics of pulmonary hypertension severity in the first 48 h in neonates with prenatally diagnosed congenital diaphragmatic hernia

Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Utility of the Oxygenation Index in Management of Congenital Diaphragmatic Hernia – a Report From a Thai University Surgical Centre

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