Our Summary

This research paper looks at the use of a life support technique called Extracorporeal Life Support (ECLS) in treating babies with a birth defect known as Congenital Diaphragmatic Hernia (CDH). CDH is a condition where there’s a hole in the diaphragm, the muscle that helps us breathe, which allows organs from the abdomen to move into the chest.

The researchers reviewed the medical records of infants with CDH between 2004 and 2014. They found that out of 177 infants diagnosed with CDH, 37% were treated with ECLS. Some of these infants had their hernia repaired while still on ECLS, while others had the repair after they were taken off ECLS.

The study found that infants who had their hernia repaired after they were taken off ECLS had better outcomes and no deaths resulting from the repair. Meanwhile, babies who had their hernia repair while still on ECLS had a lower survival rate.

It was also observed that babies treated with ECLS had longer treatment periods and higher rates of bleeding and death than those who had their repair after being taken off ECLS. Out of the deaths that occurred after hernia repair on ECLS, 18% were due to surgical bleeding and the rest were due to high blood pressure in the lungs or severe infection.

So, the study suggests that the best approach might be to wait until the baby is stable and off the ECLS before performing the hernia repair.

FAQs

  1. What is the survival rate for infants who undergo congenital diaphragmatic hernia repair post-decannulation?
  2. What are the risks associated with repairing congenital diaphragmatic hernia on extracorporeal life support (ECLS)?
  3. How does the timing of congenital diaphragmatic hernia repair impact patient outcomes?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is that it is important to consider timing of the repair in relation to extracorporeal life support (ECLS). Repairing the hernia post-decannulation may lead to excellent outcomes and lower mortality rates compared to repairing on ECLS. It is also important to be aware of the potential risks of bleeding during surgery, especially for infants undergoing repair on ECLS. Discussing these factors with your healthcare team can help guide decision-making and improve overall outcomes.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are recommended for repair typically include infants who have refractory pulmonary hypertension and require extracorporeal life support (ECLS). In this study, infants with CDH who underwent repair post-decannulation had excellent outcomes with no mortalities attributable to repair. However, infants who underwent repair on ECLS late on bypass had the lowest survival rate, with a significant portion of mortality in this group attributed to surgical bleeding. Therefore, careful consideration and evaluation of the timing of repair in infants with CDH on ECLS is important in order to optimize outcomes and minimize risks.

Timeline

Before congenital diaphragmatic hernia repair, a patient may experience symptoms such as difficulty breathing, rapid breathing, rapid heart rate, and a bluish tint to the skin due to lack of oxygen. Diagnosis is typically made through imaging studies such as ultrasound or MRI. In severe cases, the patient may require extracorporeal life support (ECLS) to stabilize their condition.

After congenital diaphragmatic hernia repair, the patient may experience a recovery period in the hospital, which may involve monitoring in the intensive care unit, pain management, and physical therapy. The patient may also need ongoing follow-up care to monitor for any potential complications such as recurrent hernias or respiratory issues. Overall, patients who undergo repair post-decannulation have excellent outcomes with no mortalities attributable to the surgery, while those repaired on ECLS have a higher risk of complications and mortality, particularly from bleeding.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing repair for congenital diaphragmatic hernia on extracorporeal life support (ECLS)?
  2. How does the timing of repair, either post-decannulation or on ECLS, impact the outcomes for infants with CDH?
  3. Are there specific factors that would make a patient a better candidate for repair on ECLS versus post-decannulation?
  4. What is the typical recovery process like for infants undergoing repair for CDH on ECLS?
  5. How often do complications, such as bleeding or mortality, occur in infants undergoing repair for CDH on ECLS?
  6. What is the overall survival rate for infants with CDH who undergo repair on ECLS compared to those who undergo repair post-decannulation?
  7. What are the long-term implications and potential complications of undergoing repair for CDH on ECLS?
  8. Are there any alternative treatment options or approaches that could be considered for infants with CDH who require repair on ECLS?
  9. How closely will the patient be monitored during and after the repair procedure for CDH on ECLS?
  10. What is the expected outcome and prognosis for infants with CDH who undergo repair on ECLS versus those who undergo repair post-decannulation?

Reference

Authors: Golden J, Jones N, Zagory J, Castle S, Bliss D. Journal: Pediatr Surg Int. 2017 Feb;33(2):125-131. doi: 10.1007/s00383-016-4002-2. Epub 2016 Nov 11. PMID: 27837262