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Journal of Perinatal Medicine Jan 2023Chronic respiratory morbidity is unfortunately common in childhood, particularly in those born very prematurely or with congenital anomalies affecting pulmonary... (Review)
Review
Chronic respiratory morbidity is unfortunately common in childhood, particularly in those born very prematurely or with congenital anomalies affecting pulmonary development and those with sickle cell disease. Our research group, therefore, has focused on the early origins of chronic respiratory disease. This has included assessing antenatal diagnostic techniques and potentially therapeutic interventions in infants with congenital diaphragmatic hernia. Undertaking physiological studies, we have increased the understanding of the premature baby's response to resuscitation and evaluated interventions in the delivery suite. Mechanical ventilation modes have been optimised and randomised controlled trials (RCTs) with short- and long-term outcomes undertaken. Our studies highlighted respiratory syncytial virus lower respiratory tract infections (LRTIs) and other respiratory viral LRTIs had an adverse impact on respiratory outcomes of prematurely born infants, who we demonstrated have a functional and genetic predisposition to respiratory viral LRTIs. We have described the long-term respiratory outcomes for children with sickle cell disease and importantly identified influencing factors. In conclusion, it is essential to undertake long term follow up of infants at high risk of chronic respiratory morbidity if effective preventative strategies are to be developed.
Topics: Child; Humans; Infant; Anemia, Sickle Cell; Lung; Respiration Disorders; Respiratory Syncytial Virus Infections; Respiratory Tract Infections; Hernias, Diaphragmatic, Congenital
PubMed: 35786507
DOI: 10.1515/jpm-2022-0257 -
Clinics in Perinatology Dec 2022Congenital diaphragmatic hernia (CDH) is a challenging surgical disease that requires complex preoperative, perioperative, and postoperative care. Survival depends on... (Review)
Review
Congenital diaphragmatic hernia (CDH) is a challenging surgical disease that requires complex preoperative, perioperative, and postoperative care. Survival depends on successful reduction and repair of the defect, and numerous complex decisions must be made regarding timing and preparation for surgery. This review describes the challenges and controversies inherent to surgical CDH care and provides recommendations for management based on the most recent evidence.
Topics: Humans; Hernias, Diaphragmatic, Congenital; Extracorporeal Membrane Oxygenation
PubMed: 36328606
DOI: 10.1016/j.clp.2022.08.004 -
Neonatal Network : NN Aug 2021Congenital diaphragmatic hernia (CDH) is a developmental defect in the diaphragm that allows abdominal viscera to herniate into the thoracic cavity. Pulmonary hypoplasia...
Congenital diaphragmatic hernia (CDH) is a developmental defect in the diaphragm that allows abdominal viscera to herniate into the thoracic cavity. Pulmonary hypoplasia and pulmonary hypertension are consequences of this disease process. The incidence is approximately 2.4-4.1/10,000 births, and survival rate is estimated at 70-90 percent. To avoid potentially devastating delays in care, it is crucial that neonatal nurses and care providers in both tertiary and nontertiary care centers be familiar with the pathogenesis of CDH and the standard of care for initial stabilization of the neonate. Novel fetal and postnatal surgical repair techniques are also described here.
Topics: Female; Fetus; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Pregnancy; Prenatal Care
PubMed: 34518382
DOI: 10.1891/11-T-701 -
HPB : the Official Journal of the... Dec 2023Post-hepatectomy diaphragmatic hernia is the second most common cause of acquired diaphragmatic hernia. This study aims to review the literature on this complication's... (Review)
Review
BACKGROUND
Post-hepatectomy diaphragmatic hernia is the second most common cause of acquired diaphragmatic hernia. This study aims to review the literature on this complication's incidence, treatment and prognosis.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed for all studies related to acquired diaphragmatic hernias after hepatectomy.
RESULTS
We included 28 studies in our final analysis, comprising 11,368 hepatectomies. The incidence of post-hepatectomy diaphragmatic hernia was 0.75% (n = 86). The most frequent type of hepatectomy performed was right hepatectomy (79%, n = 68), and the indications for liver resection were a liver donation for living donor transplantation (n = 40), malignant liver tumors (n = 13), and benign tumors (n = 11). The mean onset between liver resection and the diagnosis of diaphragmatic hernia was 25.7 months (range, 1-72 months), and the hernia was located on the right diaphragm in 77 patients (89.5%). Pain was the most common presenting symptom (n = 52, 60.4%), while six patients were asymptomatic (6.9%). Primary repair by direct suture was the most frequently performed technique (88.3%, n = 76). Six patients experienced recurrence (6.9%), and three died before diaphragmatic hernia repair (3.5%).
CONCLUSION
Diaphragmatic hernia is a rare complication occurring mainly after right liver resection. Repair should be performed once detected, given the not-negligible associated mortality in the emergency setting.
Topics: Humans; Hepatectomy; Incidence; Hernia, Diaphragmatic; Diaphragm; Liver Neoplasms
PubMed: 37648598
DOI: 10.1016/j.hpb.2023.08.008 -
Seminars in Perinatology Feb 2020Because congenital diaphragmatic hernia (CDH) is characterized by a spectrum of severity, risk stratification is an essential component of care. In both the prenatal and... (Review)
Review
Because congenital diaphragmatic hernia (CDH) is characterized by a spectrum of severity, risk stratification is an essential component of care. In both the prenatal and postnatal periods, accurate prediction of outcomes may inform clinical decision-making, care planning, and resource allocation. This review examines the history and utility of the most well-established risk prediction tools currently available, and provides recommendations for their optimal use in the management of CDH patients.
Topics: Blood Gas Analysis; Clinical Decision Rules; Echocardiography; Extracorporeal Membrane Oxygenation; Female; Head; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Liver; Lung; Magnetic Resonance Imaging; Mortality; Organ Size; Pregnancy; Prognosis; Resuscitation; Risk Assessment; Severity of Illness Index; Stomach; Thorax; Ultrasonography, Prenatal
PubMed: 31676044
DOI: 10.1053/j.semperi.2019.07.004 -
Current Opinion in Obstetrics &... Apr 2020Congenital diaphragmatic hernia (CDH) is a structural birth defect that results in significant neonatal morbidity and mortality. CDH occurs in 2-4 per 10 000... (Review)
Review
PURPOSE OF REVIEW
Congenital diaphragmatic hernia (CDH) is a structural birth defect that results in significant neonatal morbidity and mortality. CDH occurs in 2-4 per 10 000 pregnancies, and despite meaningful advances in neonatal intensive care, the mortality rate in infants with isolated CDH is still 25-30%. In this review, we will present data on the molecular underpinnings of pathological lung development in CDH, prenatal diagnosis, and prognostication in CDH cases, existing fetal therapy modalities, and future directions.
RECENT FINDINGS
Developments in the prenatal assessment and in-utero therapy of pregnancies complicated by congenital diaphragmatic hernia are rapidly evolving. Although ultrasound has been the mainstay of prenatal diagnosis, fetal MRI appears to be an increasingly important modality for severity classification. While fetal endoscopic tracheal occlusion (FETO) may have a role in the prenatal management of severe CDH cases, it is possible that future therapeutic paradigms will incorporate adjunct medical interventions with either stem cells or sildenafil in order to address the vascular effects of CDH on the developing lung.
SUMMARY
Both animal and human data have shown that the pathophysiological underpinnings of CDH are multifactorial, and it appears that future prenatal assessments and therapies will likely be as well.
Topics: Animals; Disease Models, Animal; Female; Fetoscopy; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Prenatal Diagnosis; Severity of Illness Index
PubMed: 32073442
DOI: 10.1097/GCO.0000000000000615 -
Cirugia Espanola Apr 2020
Topics: Aged, 80 and over; Hernia, Diaphragmatic; Humans; Male; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 31164215
DOI: 10.1016/j.ciresp.2019.04.016 -
Clinics in Perinatology Dec 2022Congenital diaphragmatic hernia is an anomaly that is often prenatally diagnosed and spans a wide spectrum of disease, with high morbidity and mortality associated with... (Review)
Review
Congenital diaphragmatic hernia is an anomaly that is often prenatally diagnosed and spans a wide spectrum of disease, with high morbidity and mortality associated with fetuses with severe defects. Congenital diaphragmatic hernia is thus an ideal target for fetal intervention. We review the literature on prenatal diagnosis, describe the history of fetal intervention for congenital diaphragmatic hernia, and discuss fetal endoscopic tracheal occlusion and the Tracheal Occlusion To Accelerate Lung growth trial results. Finally, we present preclinical studies for potential future directions.
Topics: Pregnancy; Female; Humans; Hernias, Diaphragmatic, Congenital; Fetal Diseases; Trachea; Fetal Therapies; Fetus; Ultrasonography, Prenatal; Lung; Fetoscopy
PubMed: 36328604
DOI: 10.1016/j.clp.2022.07.008 -
ANZ Journal of Surgery Sep 2022The majority of the diaphragmatic hernias developing on the right side are hernias developing after right hepatectomy. We aimed to present the clinical presentation at...
BACKGROUND
The majority of the diaphragmatic hernias developing on the right side are hernias developing after right hepatectomy. We aimed to present the clinical presentation at the time of admission, surgical treatment, and postoperative course of patients that developed DH following a major liver resection in our center.
PATIENTS AND METHODS
Liver surgeries performed in Ataturk University Organ Transplant Center and Ataturk University Research Hospital General surgery Hepatopancreatobiliary ward between 2012 and 2021 were analysed retrospectively. Demographic information, admission types (emergency or elective), admission clinics, the process of diaphragmatic hernia formation following hepatectomy, imaging methods used for diagnosis, and surgical methods performed were recorded for the patients with diaphragmatic hernia. Qualitative values were tabulated and their percentages were calculated.
RESULTS
Six hundred and sixty patients who underwent major liver surgery in our center between 2012 and 2021 were analysed. It was found that diaphragmatic hernia developed in 9 (1.4%) of those patients. The incidence of diaphragmatic hernia after donor hepatectomy was 3.04% in our study. The mean time from the first surgery until the DH diagnosis was 47.33 ± 38.16 months. 1 (11.1%) patient had small intestine perforation and 1 patient had both small intestine and colon perforation. One patient died before to the surgery.
CONCLUSION
DH following liver resection can cause fatal complications and it should be intervened when diagnosed. Although it is rare, centers particularly focusing on hepatobiliary surgery should determine a follow-up protocol to detect DH that develops after major liver resections.
Topics: Hepatectomy; Hernia, Hiatal; Hernias, Diaphragmatic, Congenital; Humans; Liver Transplantation; Retrospective Studies
PubMed: 35921390
DOI: 10.1111/ans.17942 -
Pediatrics International : Official... Apr 2021
Topics: Hernias, Diaphragmatic, Congenital; Humans
PubMed: 33881212
DOI: 10.1111/ped.14552