Management of congenital diaphragmatic hernia

Bösenberg, Adrian; Brown, Richard N

doi:10.1097/aco.0b013e3282f9e214

Cited by 34 publications

(31 citation statements)

References 121 publications

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“…Some centres routinely use neuromuscular blocking agents, whereas others avoid them [51], as muscle paralysis may have an adverse effect on ventilation [49]. Indications for alternative forms of support (high-frequency oscillation ventilation (HFOV), inhaled nitric oxide (iNO) and ECMO) are a pH of ,7.25, Pa,CO 2 .60 mmHg and preductal oxygen saturation less than 80-85% with an inspired oxygen concentration of 60% [52]. There is an ongoing multicentre randomised study (CDH-EURO Consortium) assessing whether elective HFOV improves survival and/or has other benefits (www.vicitrial.com); the results will be very welcome to inform the choice of respiratory support.…”

Section: Post-natal Management Of Cdh Venue and Timing Of Deliverymentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

140

122

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Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.

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Section: Post-natal Management Of Cdh Venue and Timing Of Deliverymentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

140

122

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“…Congenital diaphragmatic hernia (CDH)has an incidence of 1:3000-1:5000 per live births [7]. It is believed to be caused by failure of diaphragmatic closure, and usually presents with respiratory distress, and 40-50% of mortality in the neonate [4].…”

Section: Discussionmentioning

confidence: 99%

“…Small diaphragmatic defects, are usually repaired by primary repair with non-absorbable sutures [1]. For large defects, prosthetic patches or tissueengineered grafts are used to avoid causing excessive tension after repair [2,7]. With the development of surgical techniques, operations of CDH occur through minimally invasive techniques such as laparoscopy or thoracoscopy [3].…”

Section: Discussionmentioning

confidence: 99%

Rare Case Report – Congenital Diaphragmatic Hernia Presentation in Adult

et al. 2011

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“…Existen controversias encontrando que otros autores apoyan la cirugía en pacientes sin sínto-mas respiratorios solo cuando haya una gran eventración diafragmática que interfiera con la función pulmonar (45,46,47,48). Los pacientes que requieren apoyo ventilatorio; los que sufren infecciones pulmonares de repetición; quienes tienen síntomas gastrointestinales o detención del crecimiento deben ser operados (8,25,49,50).…”

Section: Análisis Y Discusiónunclassified

Eventración Diafragmática en Niños, Reporte De Un Caso Y Revisión De Tema.

Pérez

2015

Revisalud

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Introducción: La eventración diafragmática es un cuadro muy poco frecuente en niños, que puede cursar en forma asintomática o con manifestaciones respiratorias bajas o gastrointestinales y cuyo diagnóstico podría ser casual, al solicitar imágenes para comprobar una sospecha diagnóstica: Puede ser de causa congénita o adquirida y su tratamiento depende de los síntomas. Desarrollo: Se presenta un recorrido desde la practica por los aspectos con mayor relevancia en cuanto a una patología infrecuente, presentándose caso clínico de una escolar de 8 años de edad con EVENTRACION DIAFRAGMATICA (ED) sucedido en el Hospital Infantil Napoleón Franco Pareja (HINFP de Cartagena Colombia) con radiografía de tórax que muestra elevación de hemidiafragma derecho. El paciente cursaba asintomático al momento de la consulta y el diagnóstico fue casual con imágenes tomadas un mes antes de la consulta para descartar una infección respiratoria baja que cedió. Conclusiones: Los hallazgos y la evolución clínica de esta patología se relacionan con complicaciones como infección pulmonar crónica, ruptura diafragmática, úlceras y vólvulos de estómago en baja frecuencia. El tratamiento es un tema discutido, no se considera intervenir quirúrgicamente si el paciente está asintomático y sólo se realizan plicatura a los pacientes sintomáticos. El pronóstico de esta patología es bueno.

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Management of congenital diaphragmatic hernia

Cited by 34 publications

References 121 publications

Congenital diaphragmatic hernia

Congenital diaphragmatic hernia

Rare Case Report – Congenital Diaphragmatic Hernia Presentation in Adult

Eventración Diafragmática en Niños, Reporte De Un Caso Y Revisión De Tema.

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