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Archives of Disease in Childhood. Fetal... Apr 2024The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a 'living document'.
OBJECTIVE
The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a 'living document'.
DESIGN AND MAIN OUTCOME MEASURES
Critical appraisal of CDH literature adhering to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence accumulated between 1 January 2017 and 30 August 2022 was analysed to inform changes to existing or the development of new CDH care recommendations. Strength of consensus was also determined using a modified Delphi process among national experts in the field.
RESULTS
Of the 3868 articles retrieved in our search that covered the 15 areas of CDH care, 459 underwent full-text review. Ultimately, 103 articles were used to inform 20 changes to existing recommendations, which included aspects related to prenatal diagnosis, echocardiographic evaluation, pulmonary hypertension management, surgical readiness criteria, the type of surgical repair and long-term health surveillance. Fifteen new CDH care recommendations were also created using this evidence, with most related to the management of pain and the provision of analgesia and neuromuscular blockade for patients with CDH.
CONCLUSIONS
The 2023 Canadian CDH Collaborative's clinical practice guideline update provides a management framework for infants and children with CDH based on the best available evidence and expert consensus.
Topics: Infant; Child; Pregnancy; Female; Humans; Hernias, Diaphragmatic, Congenital; Canada; Prenatal Diagnosis; Hypertension, Pulmonary; Hypertension
PubMed: 37879884
DOI: 10.1136/archdischild-2023-325865 -
Pediatric Pulmonology Sep 2023A fetus was found to have a right diaphragmatic hernia during a prenatal ultrasonography examination late in the second trimester. A "green channel" with multi...
A fetus was found to have a right diaphragmatic hernia during a prenatal ultrasonography examination late in the second trimester. A "green channel" with multi department dynamic monitoring was instituted, at 40 + 4 weeks, with the infant under general anesthesia, hernia repair was later successfully performed. After the operation, the infant's vital signs were stable and their condition remained good during follow-up.
Topics: Pregnancy; Infant; Female; Humans; Hernias, Diaphragmatic, Congenital; Ultrasonography, Prenatal; Ultrasonography; Pregnancy Trimester, Second; Fetus
PubMed: 37314159
DOI: 10.1002/ppul.26542 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Jan 2024Congenital diaphragmatic hernia (CDH) is a rare developmental defect of the diaphragm, characterized by the herniation of abdominal contents into the chest, resulting in... (Review)
Review
Congenital diaphragmatic hernia (CDH) is a rare developmental defect of the diaphragm, characterized by the herniation of abdominal contents into the chest, resulting in varying degrees of pulmonary hypoplasia and pulmonary hypertension. Significant advances in the prenatal diagnosis and identification of prognostic factors have resulted in the continued refinement of the approach to fetal therapies for CDH. In the postnatal period, protocolized approaches to lung-protective ventilation, nutrition, prevention of infection, and early aggressive management of pulmonary hypertension have led to improved outcomes in infants with CDH. Surgical repair of CDH is not urgent in most circumstances and can be delayed until the pulmonary status of the patient has stabilized. This article provides a comprehensive review of CDH, focusing on the complex pathophysiology, advances in prenatal diagnosis, fetal interventions, and optimal postnatal management of CDH.
PubMed: 38584782
DOI: 10.5606/tgkdc.dergisi.2024.25705 -
Journal of Intensive Care Medicine Nov 2023Infants with congenital diaphragmatic hernia (CDH) benefit from comprehensive multidisciplinary teams that have experience in caring for the unique and complex issues... (Review)
Review
Infants with congenital diaphragmatic hernia (CDH) benefit from comprehensive multidisciplinary teams that have experience in caring for the unique and complex issues associated with CDH. Despite prenatal referral to specialized high-volume centers, advanced ventilation strategies and pulmonary hypertension management, and extracorporeal membrane oxygenation, mortality and morbidity remain high. These infants have unique and complex issues that begin in fetal and infant life, but persist through adulthood. Here we will review the literature and share our clinical care pathway for neonatal care and follow up. While many advances have occurred in the past few decades, our work is just beginning to continue to improve the mortality, but also importantly the morbidity of CDH.
PubMed: 37933125
DOI: 10.1177/08850666231212874