Diaphragmatic Hernia In Infants Research Articles

The Timing of Surgery for Congenital Diaphragmatic Hernia in Infants, on or after Weaning from Extracorporeal Membrane Oxygenation: A Meta-Analysis.

We conducted a meta-analysis of trials to determine the optimal time to conduct surgery for congenital diaphragmatic hernia (CDH) in infants, on or after weaning from extracorporeal membrane oxygenation (ECMO). We searched the PubMed, Embase, Scopus, and Cochrane Library databases to identify relevant articles published prior to May 2023 in which surgery was performed to treat CDH in infants. Data were collected, and continuous data were represented by the mean difference (MD) and 95% confidence interval (CI). Dichotomous data were represented by the odds ratio (OR) and 95% CI. Review Manager V.5.4 and Stata were used to synthesize results and to assess publication bias. The results showed that infants undergoing surgery after being weaned from ECMO had reduced mortality (OR, 2.40; 95% CI, 1.23-4.69; p = 0.01) and postoperative bleeding rates (OR, 16.20; 95% CI, 5.73-45.76; p < 0.00001) and reduced ECMO duration (MD, 3.47; 95% CI, 1.89-5.05; p < 0.0001) compared with those who underwent surgery while on ECMO. There was no statistically significant difference in hospital duration (MD, 5.48; 95% CI, -8.66 to 19.62; p = 0.45) or ventilator duration (MD, -1.93; 95% CI, -8.55 to 4.68; p = 0.57). We recommend weaning patients with CDH from ECMO before performing surgery.

Late diagnosis of congenital diaphragmatic hernia: a case report

BackgroundCongenital diaphragmatic hernia beyond the neonatal period is not uncommon. Its diagnosis in infancy and early childhood poses a challenge owing to different clinical presentation ranging from gastrointestinal to respiratory symptoms. These neonates are usually misdiagnosed as having pneumonia until radiological imaging picks up the defect during routine scan for worsening respiratory symptoms. In high-income countries, the survival rate for these patients has been reported to be high, while in Sub-Saharan Africa the survival rate is still low due to delayed diagnosis, delayed referral, and hence delayed management.Case reportWe present an African male baby from non-consanguineous parents, 6 weeks old, diagnosed with congenital diaphragmatic hernia at 6 weeks of age after failure to respond to antibiotics for suspected pneumonia. Despite attempts at management, he died at 5 weeks post surgery.ConclusionOur case emphasizes the importance of early clinical suspicion and early detection for a differential diagnosis of congenital diaphragmatic hernia in infants who present with respiratory symptoms not responding to antibiotics or recurrent pneumonia, and improving the availability of imaging in primary care facilities to diagnose such defects early and manage them accordingly.

Predicting Perinatal Outcomes in Fetuses with Congenital Diaphragmatic Hernia Using Ultrasound and Magnetic Resonance Imaging

Abstract Congenital diaphragmatic hernia is a congenital fetal disease, which mainly causes pulmonary hypoplasia and pulmonary hypertension. Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants, thus provide a reference for prenatal counseling, early intervention, and potential choices for the child's family. Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus. This paper discusses evaluation parameters based on these two imaging modalities.

Emergency Management of Acute Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children.

ObjectivesAcute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH.MethodsA retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted.ResultsA total of 22 patients were included in this study. All the patients presented with respiratory symptoms. Chest x-ray revealed swollen stomach and mediastinal shift. After nasogastric tube placement, fluid infusion, and nasal oxygen breathing, the symptoms in 8 patients ameliorated, and 14 patients had no signs of obvious relief. Three patients underwent the bedside percutaneous puncture of distensible stomach, and 1 patient died in the process of emergent management for critical condition. The remaining 21 patients underwent emergency surgery. Five thoracotomies and 16 thoracoscopies were performed. Five thoracoscopies that were converted to thoracotomies were required for the difficult reduction of herniated stomach. At follow-up, all patients improved their condition.ConclusionsAcute late-presenting CDH is a clinical emergency that can be fatal. The sudden and progressive expansion of the stomach is mainly responsible for this emergent condition. The prompt and effective management is key to decrease the mortality and achieve favorable prognosis.

Thoracoscopic Treatment of Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children.

Given that the application of thoracoscopic surgery to late-presenting congenital diaphragmatic hernia (CDH) in infants and children is controversial, we summarized our experiences with patients at two medical centers and aimed to discuss the safety and feasibility of thoracoscopic repair. A retrospective review of late-presenting CDH cases involving patients who underwent thoracoscopic repair from October 2010 to June 2017 was performed. Data, including patients' demographic characteristics, manipulative details, and postoperative complications, were extracted and analyzed. A total of 59 cases were included in this study. Patients ranged in age from 2 months to 8 years (mean: 18 months). Twenty-five patients presented with shortness of breath and dyspnea. Furthermore, 34 cases were found occasionally. Forty-six left-sided hernias and 13 right-sided hernias were found. Operating time ranged from 30 to 100 minutes (mean: 55 minutes), and the amount of blood loss was 3-5 mL (mean: 3.8 mL). The size of the diaphragmatic defect ranged from 2 × 2 cm to 5 × 8 cm. The chest tubes were taken out within 24 hours. The average length of postoperative hospital stay was 5.2 ± 0.4 days (range: 4-6 days). The length of the follow-up period ranged from 3 months to 3 years (mean: 18 months), with no recurrences. Thoracoscopic repair of late-presenting CDH is a safe and efficacious technique. It can facilitate the procedure and decrease the recurrence rate by shifting the focus to operative details. The prognosis is excellent once the correct operative details are achieved.

Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

An Investigation on Surgical Complications Based on Severity of Congenital Diaphragmatic Hernia in Infants Prenatally Diagnosed

An Investigation on Surgical Complications Based on Severity of Congenital Diaphragmatic Hernia in Infants Prenatally Diagnosed

Thoracoscopic Repair of Diaphragmatic Hernia in Infants: A New Modification of the Technique.

Purpose The objective of this study is to evaluate a novel simplified technique of thoracoscopic repair of congenital diaphragmatic hernia (CDH) in infants. Methods A retrospective review of the new simplified technique in 12 CDH patients admitted between March 2013 and March 2015 was performed. A needle with nonabsorbable 2-0 sutures threaded in the lumen was used to approximate edges of the hernia defect. Results A total of 12 infants with CDH underwent the repair successfully using this new technique. There were 7 boys and 5 girls with a median age of 104.7 days (range, 1 days-17 months). The mean operative time was 65 minutes (range, 35-125 minutes). No conversion or synthetic patch was required. The patients were followed up for 6 to 30 months (mean, 17.5 ± 8.5 months). There was no mortality and no recurrence. Conclusion The new modified technique of thoracoscopic diaphragmatic hernia repair reduces the difficulty of intracorporal suturing under tension.

Current Concepts in the Management of Congenital Diaphragmatic Hernia in Infants

The therapeutic approach to congenital diaphragmatic hernia (CDH) has shifted from one of immediate repair to management of pulmonary hypertension, physiologic stabilization, and delayed surgical repair. Lung hypoplasia, remodeled pulmonary vasculature, and ventricular dysfunction all contribute to the high morbidity and mortality associated with CDH. In addition, genetic syndromes associated with CDH can increase the incidence of serious anomalies and hence impact survival. Prenatal and postnatal management of infants with CDH is challenging in the best of circumstances and need multidisciplinary teams for optimal outcomes. However, advances using ultrasound and fetal MRI can predict prognosis and survival and plan for postnatal management. Survival rates for patients with CDH have increased for the past decade with better management at resuscitation; implementation of gentle ventilation strategies; and medical management of pulmonary hypertension, physiologic stabilization, and extracorporeal membrane oxygenation. However, follow-up of these infants for long-term morbidities is essential for optimal outcomes after discharge.

Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period.

Diaphragmatic hernia in infants following living donor liver transplantation: Report of three cases and a review of the literature

DH is a rare complication following LT. This report presents three cases of right-sided DH after LT using a left-sided graft. All of the patients were younger than one yr of age, and they were critically ill owing to their original disease, characterized by biliary atresia, progressive familiar intrahepatic cholestasis, and acute liver failure. DH occurred with sudden onset within three months after LT. All of the cases were promptly diagnosed and treated. A literature review of 24 cases of DH identified four factors associated with DH: left-sided graft, right-sided DH, relatively delayed onset of DH, and age-specific chief complaint. DH following LT should be considered as a potential surgical complication when a left-sided graft is used, especially in small infants with coagulopathy and malnutrition.

Laparoscopic repair of Morgagni diaphragmatic hernia in infants and children

Purpose Removal of the hernia sac for Morgagni diaphragmatic hernia repair in infants and children is a controversial issue. In our series, we elected not to excise the sac in all the cases. Methods Nine children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair without excision of the hernia sac, and we analyzed our results, complications, and outcome. Results Between January 2007 and March 2011, nine children, comprising five boys and four girls, with Morgagni hernia underwent repair laparoscopically at our hospital. The mean age of the children was 15.1 months (range, 3–38 months), mean operative time was 50.5 min, and mean hospital stay was 3.6 days. There were no intraoperative or postoperative complications. The mean follow-up time was 32.8 months (range, 6–54 months). There were no recurrences. All patients had complete obliteration of the residual cavity. Conclusion Laparoscopic closure of the defect by suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall without excision of the hernia sac is safe and effective in repairing Morgagni hernia without any risk accruing from leaving the hernia sac intact. Keywords: laparoscopic Morgagni hernia repair, Morgagni diaphragmatic hernia, retrosternal diaphragmatic hernia

The pathology, diagnosis, and treatment of congenital diaphragmatic hernia in infants

The pathology, diagnosis, and treatment of congenital diaphragmatic hernia in infants

Right-sided diaphragmatic hernia in infants after liver transplantation

Liver transplantation is just as successful in infants as in older children, but more challenging. This relates to the low weight of the recipients and to their rapidly deteriorating clinical condition (malnutrition and end-stage liver disease) ( J Pediatr 1990;117:205-210; BMJ 1993;307:825-828; Ann Surg 1996;223:658-664; Transplantation 1997;64:242-248; J Pediatr Surg 1998;33:20-23). In addition, higher rates of diaphragmatic complications have been shown to significantly correlate with a younger age ( Transplantation 2002;73:228-232; Transpl Int 1998;11:281-283; Pediatr Transplant 2000;4:39-44), but diaphragmatic hernia has never been reported as a complication of liver transplantation. In this report, 2 patients who developed diaphragmatic hernia after liver transplantation are presented. The possible role of several contributing factors resulting in diaphragmatic hernia is discussed. These factors include (1) diaphragm thinness related to low weight and malnutrition, (2) direct trauma at operation (dissection and diathermy), (3) increased abdominal pressure after transplantation caused by the use of a slightly oversized liver graft, and (4) the medial positioning of the partial liver graft in the abdomen.

Adrenal injury during repair of diaphragmatic hernia in infants : R. C. M. Cook and J. B. Beckwith. Surgery 69:251–255 (February) 1971

Adrenal injury during repair of diaphragmatic hernia in infants : R. C. M. Cook and J. B. Beckwith. Surgery 69:251–255 (February) 1971

Adrenal injury during repair of diaphragmatic hernia in infants.

Adrenal injury during repair of diaphragmatic hernia in infants.

Congenital posterolateral diaphragmatic hernia in infants.

A series of 31 patients with posterolateral congenital diaphragmatic hernia is presented. The embryology, clinical picture, diagnosis, anatomical features, operative problems and therapeutic considerations have been reviewed. At the time of operative repair 14 patients were less than 24 hours old and 17 beyond that age. Our results confirmed the experience of others that diaphragmatic hernia in infants below the age of 24 hours has a comparatively poor prognosis. In our series the mortality rate for this age group was 36% while in infants beyond this age there were no fatalities. The direct cause of death in our series was respiratory insufficiency and hypoxia. In none of these instances the affected lung expanded postoperatively and post-mortem examination provided evidence of lung hypoplasia. On the contrary, full expansion of the lung was ultimately demonstrated in all of our survivors. These observations indicate that results following operative correction of diaphragmatic hernia in neonates largely d...