PAPS PapersPerinatal management of congenital diaphragmatic hernia: when and how should babies be delivered? Results from the Canadian Pediatric Surgery Network
Section snippets
Methods
With Institutional Review Board approval, CDH cases for this study were accrued between May 2005 and November 2009 at the 16 perinatal centers, which comprise the Canadian Pediatric Surgery Network (CAPSNet). CAPSNet is a population-based, national network that collects disease-specific data on CDH from prenatal diagnosis until death or discharge from the initial hospitalization. Briefly, on-site trained research assistants abstract data from maternal and infant charts using a customized
Results
Two hundred fourteen live born babies (mean GA, 37.6 ± 4.0 weeks; mean birth weight, 3064 ± 696 g) composed the study cohort, which is summarized in Table 1. The distribution of babies by categorical GA at birth was PT, 40 (18.7%); ET, 66 (30.8%); and LT, 103 (48.1%). Birth time was specified in 192 babies, of which 69 (35.9%) were born between the hours of 8 pm and 8 am. There were 150 (70%) left-sided hernias, and 29 (13%) had major associated congenital anomalies. The mean SNAP-II score for
Discussion
The prenatal detection rate for CDH varies enormously in published studies, from 10% to 79% [13], [14], [15], reflecting variation in prenatal care protocols and sonographic surveillance. The phenomenon of “hidden mortality” associated with a prenatal diagnosis of CDH reflects increases in perceived institutional mortality rates that result from the inclusion of early deaths attributable to “severe disease” (i.e., associated malformations, severe pulmonary hypoplasia) [16], [17], [18], [19].
Acknowledgments
This work was supported by the Canadian Institutes of Health Research (MOP 69050). CAPSNet also wishes to acknowledge the Ontario Ministry of Health and Long-Term Care and the CIHR Team in Maternal Infant Care for their financial and infrastructural support.
References (24)
- et al.
Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization
J Pediatr Surg
(2007) - et al.
Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization
J Pediatr Surg
(1998) - et al.
Pulmonary hypertension in congenital diaphragmatic hernia
Semin Pediatr Surg
(2007) - et al.
Canadian Pediatric Surgical Network: a population-based pediatric surgery network and database for analyzing surgical birth defects: the first 100 cases of gastroschisis
J Pediatr Surg
(2008) - et al.
Congenital diaphragmatic hernia and associated anomalies: their incidence, identification, and impact on prognosis
J Pediatr Surg
(1994) - et al.
Mortality prediction in congenital diaphragmatic hernia
J Pediatr Surg
(2008) - et al.
Pulmonary vascular abnormalities in congenital diaphragmatic hernia
Clin Perinatol
(1996) - et al.
Congenital diaphragmatic hernia: the hidden mortality
J Pediatr Surg
(1978) - et al.
Prenatal diagnosis of congenital diaphragmatic hernia: how should the babies be delivered?
J Pediatr Surg
(2007) - et al.
Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization
Pediatr Surg Int
(2009)
Congenital diaphragmatic hernia and associated cardiovascular malformations type, frequency, and impact on management
Am J Med Genet C Semin Med Genet
Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia
Ann Surg
Cited by (32)
Expert surgical consensus for prenatal counseling using the Delphi method
2018, Journal of Pediatric SurgeryCitation Excerpt :They found that outborn birth was a significant independent predictor of mortality, and thus advocated for delivery of fetuses with prenatally diagnosed CDH in hospitals with access to a NICU. Safavi et al. [33] aimed to identify the delivery mode associated with the most favorable outcomes. In comparing vaginal delivery versus cesarean section, they found that the delivery route did not influence outcome and therefore concluded that there was no one specific delivery plan or route that was superior for fetuses with prenatally diagnosed CDH.
Perinatal Care of Infants with Congenital Birth Defects
2018, Clinics in PerinatologyCongenital diaphragmatic hernia: The role of multi-institutional collaboration and patient registries in supporting best practice
2017, Seminars in Pediatric SurgeryCitation Excerpt :In the initial analysis, survival to hospital discharge was significantly higher in high volume centers;16 however, a follow-up study with increased case numbers has shown that a survival difference attributable to center volume no longer exists within the registry.17 CAPSNet has studied the effect of gestational timing of delivery (preterm < 37 weeks; early term: 37–38 weeks; and late term > 39 weeks) and found no difference in mortality or survival outcomes according to gestational age at birth.18 The same study looked at the effect of cesarean section (C-section, planned, and unplanned) versus vaginal delivery.
Early Births and Congenital Birth Defects. A Complex Interaction.
2013, Clinics in PerinatologyCitation Excerpt :Further studies, however, have not supported these results. Safavi and colleagues50 evaluated the Canadian Pediatric Surgery Network (214 infants with CDH) and found no difference between route of delivery or the gestational age at delivery. Most recently, in the largest study to date of infants with CDH (928 infants) evaluating the United States Period Linked Birth-Infant Death database, mortality was found to be higher in infants born at 37 weeks compared with those born at 40 weeks.51
Neonatal problems of late and moderate preterm infants
2012, Seminars in Fetal and Neonatal MedicineCitation Excerpt :The association between late prematurity and cardiac malformation showed a greater than additive effect on both morbidity and mortality, although this conclusion is not universal for all malformations. For instance, a Canadian study of a national cohort of congenital diaphragmatic hernia (CDH) did not show an optimal gestational age for prenatally diagnosed CDH.50 Therefore further studies are needed to assess the role of gestation in the prognosis of infants born with severe malformations.