Wang Ying,Ma Lishan,Liu Chao,et al.Transfer and treatment mechanism and practical effect analysis of prenatally diagnosed congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,,21():58-62.[doi:10.3760/cma.j.cn.101785-202107031-011]
Transfer and treatment mechanism and practical effect analysis of prenatally diagnosed congenital diaphragmatic hernia
- Keywords:
- Hernias; Diaphragmatic; Congenital/DI; Prenatal Diagnosis; Transportation of Patients; Treatment Outcome
- Abstract:
- Objective To explore the operative and practical outcomes of transfer and treatment mechanism of congenital diaphragmatic hernia (CDH). Methods A cooperative network was established with 8 prenatal diagnosis centers in Beijing and surrounding areas.A total of 88 pregnant women received prenatal consultations of CDH from January 2018 to December 2020 and 63 CDH children were eventually transported through a green channel.The prenatal panel was dominated by neonatal surgery and obstetrics and an expert team coordinated with ultrasonic imaging and genetics for irregular multidisciplinary consultations on diagnosing and evaluating the prognosis of abnormalities.At the same time, delivery time, delivery mode, postnatal treatment and transportation, treatment and other issues were discussed, disease severity was initially determined, the potential postnatal risks were analyzed and an optimized personalized management plan was formulated. Results There were 41 boys and 22 girls.They were full-term (n=52) and premature (n=11).The median gestational age at birth was 34 weeks.Body weight was (2978.73±607.69) gram; 22 cases (34.9%) were intubated during delivery and 22 cases (34.9%) utilized a high-frequency ventilator in delivery room.The partial pressure of carbon dioxide was >70 mmHg (n=9) and <70 mmHg (n=54).The prenatal severity of CDH was severe (n=31) and moderate (n=32).The gestational week of prenatal diagnosis was (27.69±5.33) weeks.The involved side was left (n=53) and right (n=10).Fifteen cases were associated with liver herniation.Fifty-eight cases were operated with a postoperative survival rate of 87.9%(51/58).Five cases of prenatal evaluation revealed extremely severe diaphragmatic hernia.Despite comprehensive postnatal rescue, respiratory and circulatory failure occurred.Among 58 operated children, open surgery (n=8, 13.8%) and laparoscopy (n=50, 86.2%) were performed; hernia sacs was absent (n=35) and present (n=23) and 20 cases (34.5).The defect grade was B (n=20, 34.5%) and C/D (n=38, 65.5%).Patch repairing accounted for 10.3%(6/58). Conclusion The heightened treatment level of CDH depends upon a close cooperation of obstetrics and pediatrics, a dedicated professional transfer team of neonatal surgery in prenatal diagnosis and evaluation, delivery room assistance during delivery to complete postnatal rescue and transfer work and subsequent perioperative surgical management.These measures are essential for improving the prognosis of CDH.
References:
[1] Kardon G,Ackerman KG,McCulley DJ,et al.Congenital diaphragmatic hernias:from genes to mechanisms to therapies[J].Dis Model Mech,2017,10(8):955-970.DOI:10.1242/dmm.028365.
[2] Coughlin MA,Werner NL,Gajarski R,et al.Prenatally diagnosed severe CDH:mortality and morbidity remain high[J].J Pediar Surg,2016,51(7):1091-1095.DOI:10.1016/j.jpedsurg.2015.10.082.
[3] Morini F,Lally KP,Lally PA,et al.Treatment strategies for congenital diaphragmatic hernia:change sometimes comes bearing gifts[J].Original Research,2017,9(5):195.DOI:10.3389/fped.2017.00195.
[4] Snoek KG,Reiss IK,Greenough A,et al.Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe:the CDH EURO consortium consensus 2015 update[J].Neonatology,2016,110(1):66-74.DOI:10.1159/000444210.
[5] Reiss I,Schaible T,van den Hout L,et al.Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe:the CDH EURO Consortium consensus[J].Neonatology,2010,98(4):354-364.DOI:10.1159/000320622.
[6] Lazar DA,Cass DL,Rodriguez MA,et al.Impact of prenatal evaluation and protocolbased perinatal management on congenital diaphragmatic hernia outcomes[J].J Pediatr Surg,2011,46(5):808-813.DOI:10.1016/j.jpedsurg.2011.02.009.
[7] Kunz SN,Zupancic JAF,Rigdon J,et al.Network analysis:a novel method for mapping neonatal acute transport patterns in California[J].J Perinatol,2017,37(6):702-708.DOI:10.1038/jp.2017.20.
[8] Bojani? K,Priti?anac E,Lueti? T,et al.Survival of outborns with congenital diaphragmatic hernia:the role of protective ventilation,early presentation and transport distance:a retrospective cohort study[J].BMC Pediatrics,2015,15:155.DOI 10.1186/s12887-015-0473-x.
[9] Reynolds RD,Pilcher J,Ring A,et al.The Golden Hour:care of the LBW infant during the first hour of life one unit’s experience[J].Neonatal Netw,2009,28(4):211-219.DOI:10.1891/0730-0832.28.4.211.
[10] Wyckoff MH.Initial resuscitation and stabilization of the periviable neonate:the Golden-Hour approach[J].Semin Perinatol,2014,38(1):12-16.DOI:10.1053/j.semperi.2013.07003.
[11] Sharma D.Golden hour of neonatal life:Need of the hour[J].Matern Health Neonatol Perinatol,2017,3:16.DOI:10.1186/s40748-017-0057-x.
[12] 王伟鹏,潘伟华,王俊.先天性膈疝患儿围产期预后风险评估的研究进展[J].临床小儿外科杂志,2019,18(11):977-983.DOI:10.3969/j.issn.1671-6353.2019.11.016. Wang WP,Pan WH,Wang J.Research advances in assessing perinatal prognostic risks for children with congenital diaphragmatic hernia[J].J Clin Ped Sur,2019,18(11):977-983.DOI:10.3969/j.issn.1671-6353.2019.11.016.
[13] Walz PC,Schroeder JW Jr.Prenatal diagnosis of obstructive head and neck masses and perinatal airway management:the ex utero intrapartum treatment procedure[J].Otolaryngol Clin North Am,2015,48(1):191-207.DOI:10.10.1016/j.otc.2014.09.013.
[14] Wyllie J,Perlman JM,Kattwinkel J,et al.Part 11:Neonatal resuscitation:2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations[J].Resuscitation,2010,81(Suppl 1):e260-e287.DOI:10.1016/j.resuscitation.2010.08.029.
[15] Wyckoff MH,Aziz K,Escobedo MB,et al.Part 13:neonatal resuscitation:2015 american heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J].Circulation,2015,132(18 Suppl 2):S543-S560.DOI:10.1161/cir.0000000000000267.
[16] Laptook AR,Salhab W,Bhaskar B,et al.Admission temperature of low birth weight infants:predictors and associated morbidities[J].Pediatrics,2007,119(3):e643-e649.DOI:10.1542/peds.2006-0943.
Memo
收稿日期:2021-06-30。
基金项目:国家重点研发计划（2018YFC1002503）；北京市儿科学科协同发展中心儿科专项基金资助项目（XTGL201912）；北京市卫生与健康科技成果与适宜技术推广项目（BHTPP202005）；北京市儿科学科协同发展中心儿科重点专项（XTZD20180305）
通讯作者:马立霜,Email:malishuang2006@sina.com