Congenital diaphragmatic hernia |
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| Affiliation: | 1. Texas A&M University, College Station, TX, USA;2. Duke Clinical Research Institute, Durham, NC, USA;3. Department of Pediatrics, Duke University, Durham, NC, USA;4. Pediatrix Medical Group, Sunrise, FL, USA;1. Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland;2. Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada;3. Department of Physiology, University of Toronto, Toronto, Canada;4. Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada;5. Department of Neonatology, The Hospital for Sick Children, Toronto, Canada;6. The Labatt Family Heart Centre, The Hospital for Children, Toronto, Canada;7. Department of Cardiology, Our Lady''s Children''s Hospital Crumlin, Dublin, Ireland;8. Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland;1. Children''s National Health System, Fetal Medicine Institute, Division of Fetal and Transitional Medicine, 111 Michigan Avenue, NW, Washington, DC 20010, USA;2. Boston Children''s Hospital, Department of Surgery, 300 Longwood Avenue, Boston, MA 02115, USA;3. University of Central Arkansas, Department of Mathematics, 201 Donaghey Avenue, Conway, AR 72035, USA;4. SUNY Upstate Medical University, Golisano Children''s Hospital, Department of Pediatric Neurology, 750 East Adams Street, Syracuse, NY 13210, USA;1. Postgraduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil;2. MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, University of Bristol, Bristol, UK;3. Postgraduate Program in Nutrition, Federal University of Santa Catarina, Brazil;4. Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Rio Grande do Sul, Brazil |
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| Abstract: | There is a paucity of level 1 and level 2 evidence for best practice in surgical management of CDH. Antenatal imaging and prognostication is developing. Observed to expected lung-to-head ratio on ultrasound allows better predictive value over simple lung-to-head ratio. Based on 2 randomised studies, the verdict is still out in terms the best group and indication for antenatal intervention and their outcome. Tracheal occlusion is best suited for prospective randomised studies of benefit and outcome. Only one pilot randomised controlled study of thoracoscopic repair exists, suggesting increased acidosis; blood gases and CO2 levels should be closely monitored. Only poorly controlled retrospective studies suggest higher recurrence rates. Randomised studies on the outcome of thoracoscopic repair are needed. Careful selection, anaesthetic vigilance, monitoring and follow-up of these cases are required. There is no evidence to suggest the best patch material to decrease recurrences. Evidence suggests no benefit from routine fundoplication based on the one randomised study. Multi-disciplinary follow-up is required. This can be visits to different specialities, but may be best served by a multi-disciplinary one-stop clinic. |
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