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Vol. 29, No. 1, 2011
Issue release date: February 2011
Section title: Invited Review
Fetal Diagn Ther 2011;29:55–63
(DOI:10.1159/000322694)

Actual Outcome in Infants with Congenital Diaphragmatic Hernia: The Role of a Standardized Postnatal Treatment Protocol

van den Hout L.a · Schaible T.d · Cohen-Overbeek T.E.b · Hop W.c · Siemer J.e · van de Ven K.a · Wessel L.f · Tibboel D.a · Reiss I.a
aIntensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia, bDivision of Obstetrics and Prenatal Medicine, and cDepartment of Biostatistics, Erasmus MC, Rotterdam, The Netherlands; Departments of dPediatrics, eObstetrics and Gynecology, and fPediatric Surgery, Universitätsmedizin Mannheim, Mannheim, Germany

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Article / Publication Details

First-Page Preview
Abstract of Invited Review

Received: 6/7/2010
Accepted: 11/11/2010
Published online: 2/3/2011
Issue release date: February 2011

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 7

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT

Abstract

Background: Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly with a high rate of mortality and morbidity. Objective: Our aim was to determine a possible effect of standardized treatment on outcome in infants with CDH. Methods: All prenatally diagnosed patients with unilateral CDH born alive between January 2006 and December 2009 at the Erasmus MC or the University Hospital Mannheim were eligible for inclusion. Patients who underwent a fetal tracheal occlusion were excluded. From November 1, 2007, all CDH patients were treated according to a standardized treatment protocol. Patients were divided into two chronological groups according to their date of birth: without standardized treatment (group 1, Jan 2006–Oct 2007) and with standardized treatment (group 2, Nov 2007–Dec 2009). Outcome measures were mortality by day 28, bronchopulmonary dysplasia (BPD), defined as oxygen dependency at day 28, and need for extracorporeal membrane oxygenation (ECMO) therapy. Uni- and multivariate analyses were performed. Results: 167 patients were included. By day 28, 18% of the infants had died. Of the patients who were alive at day 28, 49% had BPD. An ECMO procedure was performed in 31% of the patients. Overall mortality for all included patients was 22%. In group 1, overall mortality was 33% and in group 2 overall mortality was 12% (p = 0.004). A standardized treatment protocol was independently associated with a reduced risk for mortality by day 28 (OR 0.28, 95% CI 0.11–0.68). Higher observed-to-expected lung-to-head ratios were independently associated with a lower risk for mortality by day 28 (OR 0.97, 95% CI 0.95–0.99), BPD (OR 0.97, 95% CI 0.94–0.98) and need for ECMO (OR 0.98, 95% CI 0.96–0.99). An intrathoracic position of the liver was independently associated with an increased risk for BPD (OR 3.12, 95% CI 1.41–6.90) and need for ECMO therapy (OR 3.25, 95% CI 1.54–6.88). Conclusion: Survival rates in patients with CDH increased significantly after the implementation of a standardized treatment protocol.

© 2011 S. Karger AG, Basel


  

Author Contacts

Irwin Reiss, MD, PhD
Erasmus MC-Sophia Children’s Hospital
Intensive Care and Department of Pediatric Surgery, Room SK-3254
PO Box 2060, NL–3000 CB Rotterdam (The Netherlands)
Tel. +31 107 036 455, Fax +31 107 036 288, E-Mail i.reiss@erasmusmc.nl

  

Article Information

Received: June 7, 2010
Accepted after revision: November 11, 2010
Published online: February 3, 2011
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 7, Number of References : 36

  

Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 29, No. 1, Year 2011 (Cover Date: February 2011)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Article / Publication Details

First-Page Preview
Abstract of Invited Review

Received: 6/7/2010
Accepted: 11/11/2010
Published online: 2/3/2011
Issue release date: February 2011

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 7

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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