A modern era comparison of right versus left sided congenital diaphragmatic hernia outcomes

Collin, M.; Trinder, Sarah L.; Minutillo, Corrado; Rao, Shripada; Dickinson, Jan E.; Samnakay, Naeem

doi:10.1016/j.jpedsurg.2016.05.001

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…At a gestation greater than 20 weeks, termination of pregnancy may only be performed if the fetus is likely to be born with severe medical problems. The proportion of pregnancies terminated after antenatal diagnosis of CDH is about 30.7% with a 3.2‐fold increase when occurring with other anomalies, consistent with that of previous studies in Western Australia and the United Kingdom . This is noteworthy, as it might represent a significant proportion of pregnancies with potentially good postnatal prognosis that were interrupted.…”

Section: Discussionsupporting

confidence: 87%

“…39 Moreover, with the gradual shift of timing of surgery to a less aggressive and more semielective approach to enable cardiovascular stabilization prior to surgery, there appears to have been improvement in postoperative outcomes when the same cohort in Western Australia was interrogated for postnatal outcomes. 29 dence. 27,[42][43][44] The proportion of other co-occurring congenital anomalies was 44%, also in keeping with prior population-based studies of a 37%-47% association.…”

Section: Discussionmentioning

confidence: 97%

“…Since then, there has been a progressive improvement in survival and decreased need for ECMO . Moreover, with the gradual shift of timing of surgery to a less aggressive and more semielective approach to enable cardiovascular stabilization prior to surgery, there appears to have been improvement in postoperative outcomes when the same cohort in Western Australia was interrogated for postnatal outcomes . These alterations in neonatal management strategies are reflected by a significant increase in the overall 1‐year survival rate of infants with CDH, particularly those in the isolated CDH cohort, since the inception of this ventilation strategy in Western Australia in the early 2000s, when compared with their counterparts born between 1991 and 2002.…”

Section: Discussionmentioning

confidence: 99%

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Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes

et al. 2018

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Objective This study aims to review temporal changes in perinatal management and 1‐year survival outcomes of cases of congenital diaphragmatic hernia (CDH) from 1996 to 2015 in Western Australia (WA). Method This research is a retrospective study of all cases of CDH in WA from 1996 to 2015 identified from five independent databases within the WA health network. Detailed information pertaining to pregnancy and survival outcomes were obtained from review of maternal and infant medical records. Results There were 215 cases of CDH with 164 diagnosed prenatally. Between 1996 and 2010, a decline in live birth rates for CDH‐affected pregnancies was observed, reaching a nadir of 5.3 per 10 000 births before increasing to a peak of 9.73 per 10 000 births in 2011‐2015. A corresponding decline was seen in the number of pregnancies terminated in the same period from 8.3 to 4.6 per 10 000 births (P = 0.14) and an increase in survival of live births from 38.9% to 81.3% (P = 0.01). Conclusion The improved overall survival rate in infants with CDH over the last 20 years may have resulted in an increased tendency for women to continue their pregnancy with a concomitant decline in termination rates. Information from this study will help in the counselling of women following prenatal detection of CDH.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes

et al. 2018

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“…R-CDH is relatively rare but some characteristics, including its mortality and morbidity rates, were reported recently [1][2][3][4]. As seen in this case report, R-CDH may sometimes have rare and problematic complications.…”

Section: Discussionmentioning

confidence: 59%

Prenatally diagnosed, right-sided congenital diaphragmatic hernia complicated by hepatic pulmonary fusion and intrathoracic kidney

Takezoe¹,

Nomura²,

Ogawa³

et al. 2017

Birth Defect

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Right-sided, congenital diaphragmatic hernia is not common but accounts for about 20% of all congenital diaphragmatic hernia. It sometimes has serious complications, such as intrathoracic kidney and hepatic pulmonary fusion.Here we report a rare case of right-sided diaphragmatic hernia, complicated by intrathoracic kidney and hepatic pulmonary fusion. Repair of the diaphragm via the abdominal approach was difficult and the disease recurred. The second operation was through a right thoracotomy and was successful. The biopsied specimen of the diaphragm contained hepatocytes and bile duct cells which strongly suggested the close relationship between liver and the diaphragm in this case.Right-sided, congenital diaphragmatic hernia (R-CDH) is rare compared to left-sided CDH and accounts for about 20% of the disease. R-CDH is sometimes difficult to diagnose prenatally and Duess et al. reported that prenatal diagnosis and patch closure may be risk factors for increased mortality.Furthermore, R-CDH may be complicated by some specific pathophysiological states, such as intrathoracic kidney and hepatic pulmonary fusion, which is rare but causes complicated and difficult problems for the surgical repair of the diaphragm.In this report, we describe a rare case with the combination of intrathoracic kidney and hepatic pulmonary fusion in R-CDH and discuss the etiology of the disease and surgical treatment.Correspondence to: Yutaka Kanamori, Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Jap2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan, Tel; +81-3-3416-0181, Fax; +81-3-3416-2222; E-mail: kanamori-y@ncchd.go.jp. Case reportThe patient's mother was referred to our institute at 33 weeks of gestation because her baby was suspected to have a right congenital diaphragmatic hernia. Fetal ultrasonography and fetal MRI ( Figure 1a, b) were taken; R-CDH was confirmed with right intrathoracic kidney and careful follow-up was initiated. At 38 weeks and 4 days of gestational age the female patient was born at 2,780 g birth weight and intensive care was started by the neonatologists in the neonatal care unit. A plain chest X-ray showed that the right thoracic space was occupied by the right lobe of the liver and the right lung was severely compressed (Figure 1c). Ultrasound examination revealed that the right lobe of the liver was prolapsed into the right thoracic space, the hepatic veins were draining directly into the right atrium and the inferior vena cave was defective at the retro-hepatic part. The first operation was performed at 1 day old, using an abdominal approach with a right upper transverse incision. The ventral rim of the diaphragm was formed by muscle but the postero-lateral rim was composed of a very thin membrane. This part of the membrane was biopsied, the right lobe of the liver was maneuvered into the abdominal cavity and the membranous diaphragm was taken in by non-absorbable sutures. The severe pulmonary hypertension gradually subsided but art...

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“…2,18,19 Compared with left-sided CDH, prior studies have shown that pregnancies complicated by right-sided CDH have worse, 8,17,20,21 improved, 22 or equivalent outcomes. 23,24 A recent large series of 330 neonates with CDH noted no difference in survival with regard to laterality. 22 Many of these studies have been limited by small numbers 17 of right-sided CDH and were potentially confounded as they were compilations from multiple institutions with different treatment strategies.…”

mentioning

confidence: 97%

Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

et al. 2018

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A modern era comparison of right versus left sided congenital diaphragmatic hernia outcomes

Cited by 19 publications

References 26 publications

Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes

Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes

Prenatally diagnosed, right-sided congenital diaphragmatic hernia complicated by hepatic pulmonary fusion and intrathoracic kidney

Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

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