BACKGROUND/ PURPOSE: Although intuitive, the benefit of prenatal evaluation and multidisciplinary perinatal management for fetuses with congenital diaphragmatic hernia (CDH) is unproven. We compared the outcome of prenatally diagnosed patients with CDH whose perinatal management was by a predefined protocol with those who were diagnosed postnatally and managed by the same team. We hypothesized that patients with CDH undergoing prenatal evaluation with perinatal planning would demonstrate improved outcome. METHODS: Retrospective chart review of all patients with Bochdalek-type CDH at a single institution between 2004 and 2009 was performed. Patients were stratified by history of perinatal management, and data were analyzed by Fisher's Exact test and Student's t test. RESULTS: Of 116 patients, 71 fetuses presented in the prenatal period and delivered at our facility (PRE), whereas 45 infants were either outborn or postnatally diagnosed (POST). There were more high-risk patients in the PRE group compared with the POST group as indicated by higher rates of liver herniation (63% vs 36%, P = .03), need for patch repair (57% vs 27%, P = .004), and extracorporeal membrane oxygenation use (35% vs 18%, P = .05). Despite differences in risk, there was no difference in 6-month survival between groups (73% vs 73%). CONCLUSIONS: Patients with CDH diagnosed prenatally are a higher risk group. Prenatal evaluation and multidisciplinary perinatal management allows for improved outcome in these patients.
BACKGROUND/ PURPOSE: Although intuitive, the benefit of prenatal evaluation and multidisciplinary perinatal management for fetuses with congenital diaphragmatic hernia (CDH) is unproven. We compared the outcome of prenatally diagnosed patients with CDH whose perinatal management was by a predefined protocol with those who were diagnosed postnatally and managed by the same team. We hypothesized that patients with CDH undergoing prenatal evaluation with perinatal planning would demonstrate improved outcome. METHODS: Retrospective chart review of all patients with Bochdalek-type CDH at a single institution between 2004 and 2009 was performed. Patients were stratified by history of perinatal management, and data were analyzed by Fisher's Exact test and Student's t test. RESULTS: Of 116 patients, 71 fetuses presented in the prenatal period and delivered at our facility (PRE), whereas 45 infants were either outborn or postnatally diagnosed (POST). There were more high-risk patients in the PRE group compared with the POST group as indicated by higher rates of liver herniation (63% vs 36%, P = .03), need for patch repair (57% vs 27%, P = .004), and extracorporeal membrane oxygenation use (35% vs 18%, P = .05). Despite differences in risk, there was no difference in 6-month survival between groups (73% vs 73%). CONCLUSIONS:Patients with CDH diagnosed prenatally are a higher risk group. Prenatal evaluation and multidisciplinary perinatal management allows for improved outcome in these patients.
Authors: Candace C Style; Oluyinka O Olutoye; Mariatu A Verla; Keila N Lopez; Adam M Vogel; Patricio E Lau; Stephanie M Cruz; Jimmy Espinoza; Caraciolo J Fernandes; Sundeep G Keswani; Timothy C Lee Journal: J Pediatr Surg Date: 2019-02-20 Impact factor: 2.545
Authors: Julia Wynn; Usha Krishnan; Gudrun Aspelund; Yuan Zhang; Jimmy Duong; Charles J H Stolar; Eunice Hahn; John Pietsch; Dai Chung; Donald Moore; Eric Austin; George Mychaliska; Robert Gajarski; Yen-Lim Foong; Erik Michelfelder; Douglas Potolka; Brian Bucher; Brad Warner; Mark Grady; Ken Azarow; Scott E Fletcher; Shelby Kutty; Jeff Delaney; Timothy Crombleholme; Erika Rosenzweig; Wendy Chung; Marc S Arkovitz Journal: J Pediatr Date: 2013-01-30 Impact factor: 4.406
Authors: Jamile Rizzardi Lava; Guilherme A Hettwer; Cleiton Jonei Reginatto; Guilherme Galoro; Carolina T Gehlen; Maria Cm Subtil; Vitor E Valenti; Luiz Carlos Deabreu; Carlos Bandeira de Mello Monteiro; Márcio Petenusso Journal: Int Arch Med Date: 2012-10-30