Impact of delayed repair and elective  high-frequency oscillatory ventilation  on survival of antenatally diagnosed congenital diaphragmatic hernia:  first application of these strategies  in the more “severe” subgroup  of antenatally diagnosed newborns

Desfrère, Luc; Jarreau, Pierre‐Henri; Dommergues, Marc; Brunhes, Anne; Hubert, Philippe; Nihoul‐Feketé, Claire; Mussat, P; Moriette, G

doi:10.1007/s001340051284

Cited by 94 publications

(57 citation statements)

References 29 publications

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“…These were very sick patients with overwhelming pulmonary hypoplasia and associated hypertension. The role of HFOV in CDH remains uncertain because of conflicting results [4,20,21]. Inhaled NO was given to only two patients and the benefit in the management of CDH in this series is uncertain.…”

Section: Discussionmentioning

confidence: 83%

“…With the management of CDH including delayed surgery, extracorporeal membrane oxygenation (ECMO), high-frequency oscillatory ventilation (HFOV), inhaled nitric oxide (NO), exogenous surfactant, partial liquid ventilation and synchronized ventilation, the survival rate ranges from 53 to 90% [1][2][3][4][5][6][7][8]. After Sakai et al [9] reported that early surgical repair may reduce pulmonary compliance, impede mechanical ventilation and increase circulatory instability, the treatment of CDH is no longer considered a surgical emergency.…”

Section: Introductionmentioning

confidence: 98%

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The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia

et al. 2006

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In spite of the innovations in the management of newborns with congenital diaphragmatic hernia (CDH) presenting with respiratory distress at birth, mortality and ongoing morbidity still remain high. This is a retrospective analysis of newborns with CDH to determine the immediate and long-term outcomes among survivors. Medical records of newborns with CDH and respiratory distress at birth between January 1993 and March 2002 were reviewed retrospectively. There were 45 newborns, 29 males and 16 females. Eleven newborns (24%) died during the period of preoperative stabilization, 9 from pulmonary hypoplasia and 2 with complex anomalies who were not resuscitated. Surgery was performed in 34 newborns (76%). Three died postoperatively from severe pulmonary hypoplasia and pulmonary hypertension. Eleven newborns (24%) had sepsis from coagulative-negative staphylococci. Thirty-one of 43 newborns (72%) with isolated CDH were discharged home. Twenty-seven of 31 survivors (87%) had adverse long-term outcome and 2 late deaths were from pulmonary complications. Twenty-nine of 43 newborns (67%) with isolated CDH survived. The principal determinant of survival was pulmonary hypoplasia. Eighty-seven percent of survivors have associated morbidity including ongoing pulmonary, nutritional and neuro-developmental problems. Nevertheless preoperative stabilization and delayed surgery have been a satisfactory mode of management.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 98%

The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia

et al. 2006

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“…CDH consists of a combination of pulmonary hypoplasia, abnormal pulmonary vascular growth, and a defect of the diaphragm that allows abdominal viscera to move up into the chest cavity. Despite the many advances in medical therapy and although better survival rates have been published [34,35], the mortality rate in CDH still remains around 20-40%. In the survivors, a variety of symptoms has been reported especially in the first years of life [36][37][38], but eventually most CDH survivors enjoy healthy lives [39][40][41].…”

Section: Settingmentioning

confidence: 99%

A reverse engineering approach for automatic annotation of Web pages

Virgilio

Frăsincar

Hop

et al. 2011

Multimed Tools Appl

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Purpose Relatively few attempts to measure the effects on the health-related quality of life (HRQoL) of informal caregivers within the context of economic evaluations have been reported. This paper is an exploratory attempt to find suitable methods to assess caregivers' HRQoL, using a population of parents of children with major congenital anomalies. Methods A total of 306 parents of children born with either congenital anorectal malformations (ARM) or congenital diaphragmatic hernia were surveyed. They rated their current HRQoL on the EQ-VAS. After that, they rated their HRQoL again on the assumption that someone would take over their caregiving activities completely and free of charge. Finally, the parents classified their HRQoL on the EQ-5D. The caregivers' scores on the EQ-VAS and the EQ-5D were compared with scores elicited in the general population.

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“…4 La historia quirúrgica de estos pacientes se ha modificado a través de los años, desde la intervención y reparación de manera inmediata hasta la intervención tardía de semanas o meses después de resolverse la hipertensión pulmonar del paciente. [5][6][7] Kays, et al, sugiere enfocarse de manera inmediata en los pacientes con factores de alto riesgo para entrar en ECMO y con el hígado herniado (considerado también con un factor de pobre pronóstico) y en los pacientes con un riesgo moderado de requerir ECMO, para una reparación de forma tardía y generar una sobrevida mayor al 80%, en ambas situaciones de presentación. 8 Históricamente, la terapia con membrana de oxigenación extracorpórea (ECMO), desde su primer caso, se reportó exitoso en el año de 1975 por el Dr. Robert Barlett; 9 éste se ha convertido en el estándar de manejo en pacientes críticamente enfermos en diferentes países, específicamente en los que no pueden ser oxigenados de ninguna forma, a pesar del manejo especializado con medicamentos y ventilación mecánica asistida; siguiendo los protocolos de manejo de la Organización de Soporte de Vida Extracorpórea (ELSO) y en base a la siguiente fórmula de índice de oxigenación:…”

Section: Introductionunclassified

Manejo exitoso de hernia diafragmática congénita con ECMO. Primer reporte de caso en México

et al. 2017

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ResumenINTRODUCCIÓN: la hernia diafragmática congénita es una enfermedad que afecta a 1 de 3000 recién nacidos, con un alto índice de morbilidad y mortalidad, especialmente si se presenta con otras malformaciones como las anomalías congénitas cardiacas. El manejo del paciente con este padecimiento debe ser tratado de forma multidisciplinaria e incluir su evaluación prenatal y atención posnatal.OBJETIVO: reportar el primer caso exitoso en México de un paciente con hernia diafragmática congénita manejado con membrana de oxigenación extracorpórea.CASO CLÍNICO: paciente masculino de 37.5 semanas de gestación con diagnóstico prenatal de hernia diafragmática congénita a las 24 semanas de gestación sin otras anomalías congénitas; índice pulmón/ cabeza de 1.7. A las seis horas de nacido presentó saturación de oxí-geno preductal de 78% y posductal a 58% con índice de oxigenación de 41, a pesar del tratamiento agresivo médico y ventilatorio, por lo que se necesitó la intervención e implementación de la membrana de circulación extracorpórea.PALABRAS CLAVE: hernia diafragmática congénita, ECMO, hipoplasia pulmonar, cirugía fetal, hipertensión pulmonar persistente del recién nacido. Congenital Diaphragmatic Hernia affects 1 in 3,000 births with a high incidence of morbidity and mortality, especially if it is associated with congenital malformations such as cardiac anomalies.

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Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns

Abstract: The prognosis of antenatally diagnosed CDH was improved by systematic HFOV on admission, no systematic transfer, and delayed surgery. This improvement is associated with modification of postnatal outcome.

Cited by 94 publications

References 29 publications

The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia

The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia

A reverse engineering approach for automatic annotation of Web pages

Manejo exitoso de hernia diafragmática congénita con ECMO. Primer reporte de caso en México

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