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

Crankson, Stanley; Jadaan, Saud Al; Namshan, Mohammed Al; Al-Rabeeah, Abdullah A.; Oda, Omar

doi:10.1007/s00383-006-1643-6

Cited by 41 publications

(36 citation statements)

References 38 publications

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“…Keller et al [43] [48,[59][60][61]. Bronchodilators and inhaled steroids were, at least transiently, used by the majority of CDH patients, during the first year of life and thereafter [61,62]. In other studies, however, none of the participating children had significant respiratory symptoms [63,64], suggesting that CDH patients were doing well, regarding long-term pulmonary outcome.…”

Section: Fetal Tracheal Occlusionmentioning

confidence: 98%

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The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

et al. 2008

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Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly with a mortality rate of approximately 40-50%, depending on case selection. It has been suggested that new therapeutic modalities such as nitric oxide (NO), high frequency oxygenation (HFO) and extracorporal membrane oxygenation (ECMO) might decrease mortality associated with pulmonary hypertension and the sequelae of artificial ventilation. When these new therapies indeed prove to be beneficial, a larger number of children with severe forms of CDH might survive, resulting in an increase of CDH-associated complications and/or consequences. In follow-up studies of infants born with CDH, many complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to thrive, neurocognitive defects and musculoskeletal abnormalities have been described. Long-term pulmonary morbidity in CDH consists of obstructive and restrictive lung function impairments due to altered lung structure and prolonged ventilatory support. CDH has also been associated with persistent pulmonary vascular abnormalities, resulting in pulmonary hypertension in the neonatal period.

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Section: Fetal Tracheal Occlusionmentioning

confidence: 98%

“…Effects on pulmonary function of CDH patients treated with fetal TO are preliminary. Keller et al [43] [48,[59][60][61]. Bronchodilators and inhaled steroids were, at least transiently, used by the majority of CDH patients, during the first year of life and thereafter [61,62].…”

Section: Fetal Tracheal Occlusionmentioning

confidence: 99%

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

et al. 2008

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“…The infant with a large diaphragmatic defect or need for ECMO is at greatest risk. [27][28][29][30][31][32][33][34][35][36] Nobuhara et al 27 reported developmental delay in more than 33% of their CDH survivors. McGahren et al 30 described neurologic abnormalities in 67% of infants with CDH who were treated with ECMO compared with 24% of infants with CDH who were not as ill and did not receive ECMO.…”

Section: Neurocognitive Delay and Behavioral Disordersmentioning

confidence: 99%

Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia

Newborn¹,

Lally²,

Engle³

2008

Pediatrics

220

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Infants with congenital diaphragmatic hernia often require intensive treatment after birth, have prolonged hospitalizations, and have other congenital anomalies. After discharge from the hospital, they may have long-term sequelae such as respiratory insufficiency, gastroesophageal reflux, poor growth, neurodevelopmental delay, behavior problems, hearing loss, hernia recurrence, and orthopedic deformities. Structured follow-up for these patients facilitates early recognition and treatment of these complications. In this report, follow-up of infants with congenital diaphragmatic hernia is outlined. INTRODUCTIONSurvival rates for patients with congenital diaphragmatic hernia (CDH) have increased during the past decade with the implementation of more "gentle" ventilation and physiology-specific strategies, high-frequency ventilation, extracorporeal membrane oxygenation (ECMO), and improved supportive care. 1-3 Improvement in survival rates has occurred for infants with CDH complicated by severe pulmonary hypoplasia, pulmonary hypertension, and chronic lung disease. 4 However, other significant morbidities, such as neurocognitive delay, gastroesophageal reflux, hearing loss, chest wall deformity, poor growth, hernia recurrence, and complications attributable to associated congenital anomalies, continue to affect the lives of many infants with CDH beyond the neonatal period. 1,5,6 Coordination of the complex medical and surgical needs of these infants is challenging. Comprehensive multispecialty clinics that aggregate specialty physicians and services are family-friendly and provide for collaborative evaluation and management planning. Same-site multidisciplinary service teams also improve coordination, communication, and support for the medical home pediatrician who is responsible for managing the general health care needs of the infant. Unfortunately, such multispecialty clinics are not available to all infants with CDH. The following information is intended to provide clinicians who care for infants with CDH with a template to organize a comprehensive plan for detection and management of associated morbidities. PULMONARY MORBIDITYSurvivors with CDH may require treatment beyond the initial hospitalization for chronic lung disease, bronchospasm, pulmonary hypertension, aspiration, pneumonia, and pulmonary hypoplasia. Oxygen treatment beyond the initial hospitalization may be needed for many of these infants, especially those who are treated with ECMO and a prosthetic patch. 7-9 Many survivors not treated with ECMO also receive bronchodilators and inhaled steroids. 8 At least 4% of survivors require a long-term tracheostomy. 9,10 Nearly one fourth of infants with CDH who survive have obstructive airway disease at 5 years of age, 10,11 and some have pulmonary hypertension that persists for months or years. Pulmonary hypertension that persists for more than the first few weeks after birth is a risk factor for early death. 12 Persistent abnormalities in lung function also have been demonstrated on ventilation/per...

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“…Pulmonary hypoplasia installs during prenatal development [2][3][4] and limited possibilities exist to attenuate it [5,6] . PH is likely secondary to pulmonary hypoplasia and associated underdeveloped vascular bed, which for some authors is a major determinant of postnatal clinical outcome [7] . For this reason, evaluation of PH severity is considered important for management of CDH infants in several centers [1] and its assessment is crucial to decide upon pulmonary vasodilator therapy as well as to monitor its effects [8,9] .…”

Section: Introductionmentioning

confidence: 99%

N-Terminal-pro-B Type Natriuretic Peptide as a Useful Tool to Evaluate Pulmonary Hypertension and Cardiac Function in CDH Infants

Baptista¹,

Rocha²,

Clemente³

et al. 2007

Neonatology

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Objective: In congenital diaphragmatic hernia (CDH) the severity of pulmonary hypertension (PH) is considered, by several authors, determinant of clinical outcome. Plasmatic N-terminal-pro-B type natriuretic peptide (NT-proBNP) might be useful in diagnosis and management of PH in newborns, although its interest in CDH infants remains to be defined. Early NT-proBNP levels were assessed in CDH infants and correlated with cardiovascular echocardiographic parameters. Patients and Methods: 28 newborns, CDH and age-matched controls were enrolled in a prospective study. Clinical condition, NT-proBNP plasmatic levels, echo parameters of PH and biventricular function were assessed at 24 h after delivery as well as survival outcome. Results: Estimated mean pulmonary pressure and NT-proBNP were significantly higher in CDH than control infants. NT-proBNP significantly correlated with estimated pulmonary artery pressure, right ventricular Tei index, and tricuspid E/A ratio. Additionally, we found that CDH infants with NT-proBNP >11,500 pg/ml experienced a worse prognosis. Conclusions: We demonstrated that PH is associated with NT-proBNP elevation and diastolic impairment in CDH infants. Early elevations in NT-proBNP levels seem to alert for a subset of CDH infants with worse prognosis.

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

Cited by 41 publications

References 38 publications

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia

N-Terminal-pro-B Type Natriuretic Peptide as a Useful Tool to Evaluate Pulmonary Hypertension and Cardiac Function in CDH Infants

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