Our Summary

This study looked at the timing of repair surgery for newborn babies with a condition called Congenital Diaphragmatic Hernia (CDH). CDH is a birth defect where there is a hole in the diaphragm, which can cause the organs in the abdomen to shift into the chest. In severe cases, this can cause problems with lung development and life-threatening breathing difficulties.

The researchers looked at two groups of babies - those who had surgery while on a life-support machine (known as ECMO), and those who had surgery after they had been taken off the ECMO machine. They matched the babies in each group for severity of their condition before they went on ECMO.

They found that babies who had surgery while still on ECMO had over three times the odds of dying compared to those who had surgery after coming off ECMO. They also found that the odds of serious brain injury were higher for babies who had surgery while on ECMO.

Even when they took into account how long the babies were on ECMO, the odds of dying were still higher for babies who had surgery while on ECMO. However, the odds of serious brain injury were not significantly higher.

The researchers concluded that if a baby can be successfully taken off ECMO and then have their CDH repair surgery, there may be a survival benefit to delaying the surgery until after they come off the ECMO machine.

FAQs

  1. What is the potential benefit of delaying CDH repair until after decannulation?
  2. How does on-ECMO repair impact the odds of mortality and severe neurologic injury (SNI) in patients with CDH?
  3. What is the impact of the length of ECMO on the outcomes of CDH repair?

Doctor’s Tip

A doctor may advise a patient with congenital diaphragmatic hernia repair to consider delaying the repair until after being liberated from ECMO, as this may confer a potential survival benefit. It is important to discuss this option with your healthcare provider to determine the best course of action for your specific situation.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are recommended for repair typically include neonates who require extracorporeal membrane oxygenation (ECMO) support. This study suggests that delaying CDH repair until after decannulation from ECMO may confer a survival benefit for these patients. It is important to consider the severity of the disease and individual patient factors when determining the timing of CDH repair.

Timeline

  • Before CDH repair: The patient may experience respiratory distress, difficulty breathing, feeding difficulties, and other symptoms related to the hernia. They may undergo diagnostic tests such as ultrasound or MRI to confirm the diagnosis and assess the severity of the hernia. In severe cases, the patient may require ECMO for respiratory support.
  • After CDH repair: The patient undergoes surgery to repair the hernia, which may involve closing the hole in the diaphragm and/or repositioning abdominal organs. The patient may require postoperative care in the ICU, including mechanical ventilation and monitoring for complications. Recovery and rehabilitation may be needed to address any long-term effects of the hernia and surgery. In some cases, patients may experience complications such as SNI. Delaying CDH repair until after ECMO decannulation may confer a survival benefit and reduce the risk of SNI.

What to Ask Your Doctor

  1. What are the risks and benefits of delaying CDH repair until after ECMO compared to having the repair done while on ECMO?
  2. How will delaying CDH repair until after ECMO impact my baby’s chances of survival?
  3. Are there any specific factors that should be considered when determining the timing of CDH repair in my baby’s case?
  4. What is the typical recovery process after CDH repair, and how does the timing of the repair impact this process?
  5. Are there any long-term consequences or complications associated with delaying CDH repair until after ECMO?
  6. How will the decision to delay CDH repair until after ECMO affect my baby’s overall prognosis and quality of life?

Reference

Authors: Delaplain PT, Harting MT, Jancelewicz T, Zhang L, Yu PT, Di Nardo M, Chen Y, Stein JE, Ford HR, Nguyen DV, Guner Y. Journal: J Pediatr Surg. 2019 Jun;54(6):1132-1137. doi: 10.1016/j.jpedsurg.2019.02.052. Epub 2019 Mar 1. PMID: 30898399