Impact of prenatal evaluation and protocol-based perinatal management on congenital diaphragmatic hernia outcomes

Lazar, David A.; Cass, Darrell L.; Rodríguez, M. Acosta; Hassan, Saif F.; Cassady, Christopher I.; Johnson, Yvette R.; Johnson, Karen E.; Johnson, Anthony; Moise, Kenneth J.; Belleza-Bascon, Bella; Olutoye, Oluyinka O.

doi:10.1016/j.jpedsurg.2011.02.009

Cited by 68 publications

(43 citation statements)

References 38 publications

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“…(parent of a baby with an abdominal cyst: PNI No. 6) Parents expressed a relief of some anxiety after meeting with the surgeon, as the surgeon was able to address uncertainty. Meeting with the surgeon made parents feel like someone was on their side, and they were able to gain trust and confidence in the person who would be caring for their child:…”

Section: Themesmentioning

confidence: 99%

“…Little is known about the parent perspective on these encounters, though some reports suggest they can be anxiety-provoking for parents [1][2][3] or that parents, in general, are dissatisfied with these encounters [4]. Other reports cite a positive effect of education transmitted during these encounters on reducing parental anxiety, even resulting in superior outcomes [5,6].…”

mentioning

confidence: 99%

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Understanding the Parent Perspective on Prenatal Consultation for Fetuses with Congenital Anomalies

Berman

Costanzo²,

Smola³

et al. 2017

Fetal Diagn Ther

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Introduction: An increasing number of congenital anomalies are diagnosed prenatally. Understanding the implications of these diagnoses on the life of their child is critical for parents, and the surgical consultation is often the primary venue for this education. Little is known about the parent perspective on prenatal consultation. Methods: Parents undergoing prenatal consultation were identified and in-depth interviews were conducted to explore the following: understanding of the diagnosis, preparedness for postnatal course, and suggestions for improvement. Qualitative analysis was performed to generate themes. Results: Twelve interviews with 16 family members were performed, encompassing a variety of prenatal diagnoses and outcomes. Near-ubiquitous emotions included fear, anxiety, and self-blame. Surgical consultation relieved anxiety for some, but the uncertain outcome increased anxiety in others. Most were satisfied with the information communicated during the encounter; however, those with worse outcomes wished they were better warned. Parents emphasized the importance of support systems and educational materials. Conclusions: Parents appreciate learning about all potential outcomes for the fetus, even though this generates anxiety. Surgeons should discuss the range of possible outcomes while acknowledging that uncertainty leads to anxiety. It is essential to incorporate the parent perspective when conducting prenatal consultation and training pediatric surgeons in this important practice.

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Section: Themesmentioning

confidence: 99%

mentioning

confidence: 99%

Understanding the Parent Perspective on Prenatal Consultation for Fetuses with Congenital Anomalies

Berman

Costanzo²,

Smola³

et al. 2017

Fetal Diagn Ther

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“…Prenatal diagnosis allows for counseling and delivery planning at a tertiary center. Even though studies indicated that infants with a prenatal diagnosis of CDH represent a group with worse outcome already 2 decades ago, there have been reports from other institutions that could not observe any differences in long-term outcomes or survival [9,10]. These differences are believed to be due to variable degrees of pulmonary hypoplasia depending on the duration of compression exerted by the viscera [10,11].…”

Section: Introductionmentioning

confidence: 99%

Differences in Outcomes in Prenatally Diagnosed Congenital Diaphragmatic Hernia Compared to Postnatal Detection: A Single-Center Experience

Burgos¹,

Hammarqvist-Vejde

Frenckner³

et al. 2015

Fetal Diagn Ther

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Objectives: To compare outcomes in pregnancies with a prenatal detection of congenital diaphragmatic hernia (CDH) with children diagnosed after birth, treated at the same institution, and to determine the ability to predict prognosis through measurements of the observed to expected lung-to-head ratio (O/E LHR). Methods: This is a retrospective review of all children with CDH treated at our institution during 2006-2014. We compared outcomes of infants referred for surgery after postnatal diagnosis with outcomes of infants with prenatally diagnosed CDH. Results: In the prenatal group, O/E LHR was significantly different between survivors and deceased patients, with a cutoff at 35% O/E LHR. Survival to discharge and 1-year survival were significantly higher in the postnatal group that required intubation within 24 h; i.e., 92 and 89% versus 85 and 73% in the prenatal group (p < 0.05). There was less need for extracorporeal membrane oxygenation (ECMO), 41 versus 60%, and patch, 41 versus 75% (p < 0.001), in the postnatal group with early diagnosis compared with the prenatal group, respectively. Conclusion: Children with prenatally diagnosed CDH represent a population with a more severe condition compared to infants diagnosed after birth. They have poorer outcomes with higher needs for ECMO or use of patch, and lower survival rates were observed at an O/E LHR below 35%.

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“…A prenatal diagnosis of CDH could prompt the transfer of the mother and fetus to a tertiary care center specialized in CDH cases. [9][10][11][12] Therefore, invasive antenatal interventions have been proposed to promote in utero lung growth and decrease neonatal CDH mortality, with the most promising one being fetal endoscopic tracheal occlusion (FETO). Tracheal occlusion prevents the amniotic fluid outfl ow from the lungs into the amniotic cavity.…”

Section: Introductionmentioning

confidence: 99%

Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

et al. 2014

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Impact of prenatal evaluation and protocol-based perinatal management on congenital diaphragmatic hernia outcomes

Cited by 68 publications

References 38 publications

Understanding the Parent Perspective on Prenatal Consultation for Fetuses with Congenital Anomalies

Understanding the Parent Perspective on Prenatal Consultation for Fetuses with Congenital Anomalies

Differences in Outcomes in Prenatally Diagnosed Congenital Diaphragmatic Hernia Compared to Postnatal Detection: A Single-Center Experience

Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

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