Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies
- 19 July 2007
- journal article
- review article
- Published by Springer Science and Business Media LLC in Journal of Perinatology
- Vol. 27 (9), 535-549
- https://doi.org/10.1038/sj.jp.7211794
Abstract
Recent reports suggest that specific care strategies improve survival of infants with congenital diaphragmatic hernia (CDH). This review presents details of care from centers reporting high rates of survival among CDH infants. We conducted a MEDLINE search (1995 to 2006) and searched all citations in the Cochrane Central Register of Controlled Trials. Studies were included if they contained reports of >20 infants with symptomatic CDH, and >75% survival of isolated CDH. Thirteen reports from 11 centers met inclusion criteria. Overall survival, including infants with multiple anomalies, was 603/763 (79%; range: 69 to 93%). Survival for isolated CDH was 560/661 (85%; range: 78 to 96%). The frequency of extracorporeal membrane oxygenation (ECMO) use for isolated CDH varied widely among reporting centers 251/622 (40%; range: 11 to 61%), as did survival for infants with isolated CDH placed on ECMO: 149/206 (73%; range: 33 to 86%). There was no suggestion of benefit from use of antenatal glucocorticoids given after 34 weeks gestation or use of postnatal surfactant. Low mortality was frequently attributed to minimizing lung injury and adhering to center-specific criteria for ECMO. Use of strategies aimed at minimizing lung injury, tolerance of postductal acidosis and hypoxemia, and adhering to center-specific criteria for ECMO were strategies most consistently reported by successful centers. The literature lacks randomized clinical trials of these or other care strategies in this complex patient population; prospective studies of safety and long-term outcome are needed.Keywords
This publication has 66 references indexed in Scilit:
- Correction of congenital diaphragmatic hernia in utero VIII: Response of the hypoplastic lung to tracheal occlusionJournal of Pediatric Surgery, 1996
- Evaluation of left ventricular mass in children with left-sided congenital diaphragmatic herniaThe Journal of Pediatrics, 1994
- A prospective randomized trial of delayed versus immediate repair of congenital diaphragmatic herniaJournal of Pediatric Surgery, 1994
- Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: Evidence of persistent surfactant deficiencyJournal of Pediatric Surgery, 1994
- Inhaled nitric oxide in infants referred for extracorporeal membrane oxygenation: Dose responseThe Journal of Pediatrics, 1994
- Congenital diaphragmatic hernia: Predictors of severity in the ECMO eraJournal of Pediatric Surgery, 1991
- Congenital diaphragmatic hernia, extracorporeal membrane oxygenation, and death: A spectrum of etiologiesJournal of Pediatric Surgery, 1991
- Effect of preoperative stabilization on respiratory system compliance and outcome in newborn infants with congenital diaphragmatic herniaThe Journal of Pediatrics, 1991
- Effect of surgical repair on respiratory mechanics in congenital diaphragmatic herniaThe Journal of Pediatrics, 1987
- Congenital diaphragmatic hernia: Arterial structural changes and persistent pulmonary hypertension after surgical repairThe Journal of Pediatrics, 1985