George Mychaliska1, Benjamin Bryner2, Ronald Dechert2, Jeannie Kreutzman2, Mike Becker2, Ronald Hirschl2. 1. Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI. Electronic address: mychalis@med.umich.edu. 2. Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI.
Abstract
BACKGROUND: Mechanical transduction has been shown to promote fetal lung growth. We examined the safety and efficacy of perflubron-induced lung growth (PILG) in neonates with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO). METHODS:Infants with left-sided CDH requiring ECMO were eligible. Exclusion criteria included active air leak, intracranial hemorrhage, major congenital anomalies, and oxygenation index >25 for 24hours. Perflubron was instilled endotracheally and continuous positive airway pressure was applied without ventilation. Survival to discharge was the primary outcome. Daily chest radiographs were used to quantify lung size (the secondary outcome). Midway through the study our institutional practice shifted toward earlier repair of CDH. RESULTS: Eight infants were randomized to each arm. In the conventional-ventilation arm, six survived to discharge (75%). In the perflubron arm, four survived (50%); the others succumbed to suprasystemic pulmonary hypertension. No adverse events related to perflubron occurred. Within the perflubron group, 4/8 patients had "late repair" (15-19days of life [DOL]) and 4 had "early repair" (2-3 DOL). "Early repair" patients had similar total lung growth, but accelerated growth and shorter ECMO runs. CONCLUSION:PILG is safe in CDH and doubles the total lung size on average (accelerated with early repair). Despite amelioration of pulmonary hypoplasia with PILG, pulmonary hypertension persists.
RCT Entities:
BACKGROUND: Mechanical transduction has been shown to promote fetal lung growth. We examined the safety and efficacy of perflubron-induced lung growth (PILG) in neonates with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO). METHODS:Infants with left-sided CDH requiring ECMO were eligible. Exclusion criteria included active air leak, intracranial hemorrhage, major congenital anomalies, and oxygenation index >25 for 24hours. Perflubron was instilled endotracheally and continuous positive airway pressure was applied without ventilation. Survival to discharge was the primary outcome. Daily chest radiographs were used to quantify lung size (the secondary outcome). Midway through the study our institutional practice shifted toward earlier repair of CDH. RESULTS: Eight infants were randomized to each arm. In the conventional-ventilation arm, six survived to discharge (75%). In the perflubron arm, four survived (50%); the others succumbed to suprasystemic pulmonary hypertension. No adverse events related to perflubron occurred. Within the perflubron group, 4/8 patients had "late repair" (15-19days of life [DOL]) and 4 had "early repair" (2-3 DOL). "Early repair" patients had similar total lung growth, but accelerated growth and shorter ECMO runs. CONCLUSION: PILG is safe in CDH and doubles the total lung size on average (accelerated with early repair). Despite amelioration of pulmonary hypoplasia with PILG, pulmonary hypertension persists.
Authors: Mansi Shah; Michael R Phillips; Benjamin Bryner; Ronald B Hirschl; George B Mychaliska; Sean E McLean Journal: Pediatr Surg Int Date: 2016-03-23 Impact factor: 1.827
Authors: Joseph T Church; Elena M Perkins; Megan A Coughlin; Jennifer S McLeod; Katherine Boss; J Kelley Bentley; Marc B Hershenson; Raja Rabah; Robert H Bartlett; George B Mychaliska Journal: Neonatology Date: 2018-02-23 Impact factor: 4.035
Authors: Joseph T Church; Megan A Coughlin; Elena M Perkins; Hayley R Hoffman; John D Barks; Raja Rabah; J Kelley Bentley; Marc B Hershenson; Robert H Bartlett; George B Mychaliska Journal: J Pediatr Surg Date: 2018-06-08 Impact factor: 2.545