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Therapeutic algorithm in cases with congenital diaphragmatic hernia of the Bochdalek type
Alexander S Yonkov1, Iliana K Yazova, Dimitar N Chatalbashev
1Clinic of Pediatric Surgery, University Hospital "St. George", Medical University, Plovdiv, Bulgaria.
Insights
Delayed surgical treatment for congenital diaphragmatic hernia offers stabilization benefits but shows high mortality. New methods like antenatal intervention may be crucial for improving survival rates in these critical pediatric cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) presents significant challenges in neonates.
- Current treatment often involves emergency surgical correction, which can be associated with high morbidity and mortality.
Purpose of the Study:
- To evaluate the effectiveness of a delayed surgical intervention approach for pediatric congenital diaphragmatic hernia.
- To compare this strategy with emergency surgical treatment.
Main Methods:
- A ten-year retrospective study of 27 children (24 neonates) with CDH.
- Preoperative stabilization using mechanical ventilation (conventional and high-frequency oscillating) was assessed using specific gas exchange criteria (SaO2, PaO2, PaCO2, pH).
Main Results:
- Left-sided hernias were predominant (92.59%).
- The mean stabilization period was 1.48 days.
- Despite stabilization efforts, the overall mortality rate was 59.26%, with three deaths occurring preoperatively due to failed stabilization.
Conclusions:
- Delayed surgical treatment for CDH allows for improved gas exchange and pulmonary circulation stabilization.
- However, the high mortality rate underscores the need for novel therapeutic strategies.
- Antenatal interventions and pulmonary transplantation are suggested as potential future solutions.
Unlabelled:
The PURPOSE of the present study was to establish the treatment results of the applied approach for preoperative stabilization through mechanical ventilation and delayed surgical intervention as opposed to emergency surgical treatment in children with congenital diaphragmatic hernia.
Patients And Methods:
Twenty-seven children have been treated (nine girls and 18 boys, twenty-four of them--newborns) over a ten-year period. The criteria for successful stabilization are arterial saturation of SaO2 90%, PaO2 = 90-100 mm Hg, PaCO2 40 mm Hg, pH 7.35.
Results:
Twenty-five of the children were with left-sided hernia (92.59%) and only two (7.41%) with right-sided hernia. The stabilization period ranged from 1 to 4 days, mean 1.48 +/- 0.18 (Sx = 0.81). Preoperatively, in eighteen newborns we used conventional mechanical ventilation; in one child only we used high frequency oscillating ventilation. In three children we failed to achieve stabilization and after worsening of their condition they died before they could be operated. In all children, postoperative mechanical ventilation was applied from 3 to 16 days, mean 7 +/- 0.65 (Sx = 3.16). The mortality was 59.26%.
Conclusions:
The approach used for delayed surgical treatment has significant advantages compared to the urgent correction of the congenital diaphragmatic hernia. It provides opportunities for stabilization of the gas exchange and pulmonary circulation but still mortality remains high. New therapeutic techniques such as antenatal intervention or pulmonary transplantation are probably needed to save the lives of such patients.
