Related Experiment Video
Updated: May 11, 2026
Transuterine Fetal Tracheal Occlusion Model in Mice
Published on: February 5, 2021
Stability prior to surgery in Congenital Diaphragmatic Hernia: is it necessary?
Alana L Beres1, Pramod S Puligandla, Mary E Brindle
1The Montreal Children's Hospital, Division of Pediatric General and Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Infants with congenital diaphragmatic hernia (CDH) can survive surgery even if they don't meet strict pre-operative stability criteria. This study suggests repairing CDH in infants regardless of their pre-operative condition for better outcomes.
Area of Science:
- Pediatric surgery
- Neonatal critical care
- Congenital anomalies
Background:
- Clinical stability is often required before congenital diaphragmatic hernia (CDH) surgery in infants.
- Pre-established criteria for stability are inconsistently defined and frequently unmet.
- Infants failing to meet stability criteria may still achieve survival.
Purpose of the Study:
- To evaluate the survival rates of infants with CDH undergoing surgery without meeting pre-established stability criteria.
- To determine if infants not meeting strict or lenient pre-operative stability criteria can achieve meaningful survival.
Main Methods:
- Analysis of infants from the CAPSNet database (2005-2010) undergoing operative repair.
- Categorization into strict (FiO2<0.40, conventional ventilation, SpO2>92%, no inotropes/vasodilators) or lenient (FiO2<0.60, conventional ventilation, SpO2>88%, no vasodilators) criteria groups.
- Univariate analysis comparing survivors and non-survivors based on pre-operative characteristics.
Main Results:
- 85% of infants (294/294) survived to surgery.
- Predictors of post-operative survival included prenatal liver position, oxygen requirements, inotrope use, and non-conventional ventilation.
- Infants meeting strict criteria had 99% survival; lenient criteria infants comprised 70% of survivors.
- Nearly one-third of survivors did not meet either strict or lenient criteria.
Conclusions:
- Infants with CDH demonstrate good survival rates even when pre-operative stability criteria are not met.
- Surgical repair should be considered for all infants with CDH, irrespective of their adherence to lenient pre-operative ventilatory, inotropic, or vasodilator requirements.
Background:
Delaying surgery for infants with CDH until they achieve clinical stability is common practice. Stability, however, is inconsistently defined, and many infants fail to reach pre-established criteria. We sought to determine if infants undergoing surgery without meeting pre-established criteria could achieve meaningful survival.
Methods:
All infants in the CAPSNet database were analyzed (2005-2010). Patients undergoing operative repair were divided into two groups based on whether they met strict (FiO2<0.40, conventional ventilation, preductal saturation >92%, no inotropes or vasodilators), or lenient (FiO2 <0.60, conventional ventilation, preductal saturation >88%, no vasodilators) criteria. Univariate analyses were performed comparing characteristics of those who survived after surgery (N=273) with those who did not (N=21).
Results:
294 patients (85%) survived to surgery. Predictors of post-operative survival included prenatal liver position (p=0.003), preoperative oxygen requirements (p=0.008), preoperative inotropes (p<0.0001), and non-conventional ventilation (p=0.004). Infants meeting strict criteria had increased survival (99%; p<0.0001). Infants meeting lenient criteria constituted 70% of survivors. Nearly one-third of survivors met neither strict nor lenient criteria.
Conclusions:
Infants with CDH can achieve good survival even when criteria for pre-operative stability are not met. We suggest that all infants should be repaired even if lenient criteria for ventilatory, inotrope, or vasodilator requirements are not achieved.
