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Efficacy of protocolized management for congenital diaphragmatic hernia. a review of 100 cases
Manabu Okawada1, Tadaharu Okazaki, Atsuyuki Yamataka
1Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Insights
Protocolized management (PM) improves survival rates for congenital diaphragmatic hernia (CDH) cases, especially when diagnosed prenatally. This approach also significantly reduces hospital stay duration.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) is a severe condition requiring specialized management.
- Current management strategies for CDH vary, impacting patient outcomes.
- Protocolized management (PM) aims to standardize care for CDH patients.
Purpose of the Study:
- To evaluate the efficacy of protocolized management (PM) in a cohort of congenital diaphragmatic hernia (CDH) cases.
- To assess the impact of prenatal diagnosis (PD) on survival rates in CDH patients.
- To determine if PM improves outcomes for prenatally diagnosed CDH cases.
Main Methods:
- Retrospective review of 100 consecutive congenital diaphragmatic hernia (CDH) cases.
- Exclusion of cases with late symptom onset or fatal anomalies.
- Categorization of 79 subjects into four groups based on prenatal diagnosis (PD) and protocolized management (PM) status.
- Analysis of survival rates, length of hospital stay, and predictors of survival.
Main Results:
- Overall survival rates were 73.5% (no PD, no PM), 75% (no PD, PM), 38.1% (PD, no PM), and 70.0% (PD, PM).
- Protocolized management (PM) was associated with higher survival (70.8%) compared to no PM (60.0%).
- Prenatal diagnosis (PD) alone was linked to lower survival (53.7%), but PM improved outcomes in PD+ cases (P < 0.05).
- PM significantly reduced hospital stay (35.5 vs. 52.0 days).
- Echocardiography (EC) predicted survival, while post-ductal AaDO2 did not.
Conclusions:
- Protocolized management (PM) shows promise in improving outcomes for congenital diaphragmatic hernia (CDH), particularly for prenatally diagnosed cases.
- While PM appears beneficial, its specific components require further investigation in prospective trials.
- PM significantly shortens hospital stays for CDH patients.
Abstract:
A review of 100 consecutive cases of congenital diaphragmatic hernia (CDH) treated at our institute focusing on the efficacy of protocolized management (PM) was conducted. Of the 100 cases, 14 who became symptomatic more than 24 h after birth, and seven with fatal anomalies (four cardiac and three chromosomal) were excluded, leaving 79 subjects for this study. Of these, 41 were diagnosed prenatally (PD). Subjects were divided into four groups. Group I: No PD, no PM (n = 34), Group II: No PD, PM (n = 4), Group III: PD, no PM (n = 21), and Group IV: PD, PM (n = 20). PM includes criteria for planned delivery, use of high frequency oxygenation, nitric oxide, echocardiography (EC), and a medication schedule. Overall survival rates for Groups I, II, III, and IV were 73.5% (25/34), 75% (3/4), 38.1% (8/21), and 70.0% (14/20), respectively. Survival rates were higher when PM was used: 70.8% (Groups II, IV) versus 60.0% (Groups I, III). Survival rates were significantly lower if diagnosed prenatally (PD+): 53.7% (Groups III, IV) versus 73.7% (Groups I, II) (P < 0.01). However, in PD+ groups, survival was significantly higher if PM was used (P < 0.05). PM significantly reduced length of hospital stay (35.5 vs. 52.0 days: P < 0.05). EC was found to be a predictor for survival while post-ductal AaDO(2) was not. In 17 cases with cardiac anomalies, PM did not affect survival. Our study suggests that use of PM for prenatally diagnosed CDH cases is associated with improved outcome, although the components of PM need to be tested in prospective trials to determine their true value.
