Our Summary

This research paper investigates the location of surgical repair for newborn babies with a specific birth defect, congenital diaphragmatic hernia (CDH). This defect can cause severe breathing difficulties and these babies often need help from machines to breathe (high frequency oscillatory ventilation or HFOV), a sort of life support called extracorporeal membrane oxygenation (ECMO), and/or a special gas called inhaled nitric oxide (iNO). Sometimes, these surgeries happen in the neonatal intensive care unit (NICU) instead of an operating room (OR) to avoid potential issues with moving the baby.

The study looked at babies admitted to the NICU in the first two weeks of life at a specific children’s hospital from July 2004 to September 2021. They found that more surgeries were performed in the OR than in the NICU. However, the babies who had their surgeries in the NICU were generally sicker and needed more intensive treatments. These babies also had higher rates of in-hospital death and overall mortality. For babies who were on ECMO, the location of the surgery didn’t significantly affect their chances of survival. There was no significant difference in the rate of infection at the surgical site between the two locations, suggesting that bedside surgeries in the NICU can be done safely when necessary, despite not having access to all the usual operating room equipment.

FAQs

  1. What is congenital diaphragmatic hernia (CDH) and how is it treated in newborns?
  2. What were the findings of the study regarding the location of CDH surgeries and its impact on the patients’ survival rates?
  3. Is there a significant difference in the rate of infection at the surgical site between surgeries performed in the NICU and in the OR?

Doctor’s Tip

One helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to ensure that their baby receives the necessary intensive treatments and monitoring before and after the surgery, regardless of whether the surgery takes place in the NICU or the OR. It is important for parents to trust the medical team’s judgment in choosing the most appropriate location for the surgery based on the baby’s individual needs and condition. It is also important to follow post-operative care instructions closely to ensure the best possible outcome for the baby.

Suitable For

In general, patients with congenital diaphragmatic hernia who are recommended for surgical repair are newborn babies with severe breathing difficulties requiring mechanical ventilation, ECMO, and/or iNO. These babies may be considered for surgery in the NICU if they are too unstable to be moved to the OR. However, the study mentioned above suggests that babies who undergo surgery in the NICU may have poorer outcomes compared to those who have surgery in the OR. Ultimately, the decision on where to perform the surgery will depend on the individual patient’s condition and the expertise of the medical team.

Timeline

  • Before congenital diaphragmatic hernia repair:
  1. Baby is born with CDH, a birth defect causing breathing difficulties.
  2. Baby may require assistance from machines to breathe, such as HFOV, ECMO, or iNO.
  3. Baby may be admitted to the NICU for monitoring and treatment.
  4. Surgical repair is scheduled to correct the hernia and improve breathing.
  • After congenital diaphragmatic hernia repair:
  1. Surgery is performed in either the NICU or OR, depending on the baby’s condition.
  2. Babies who undergo surgery in the NICU are typically sicker and require more intensive treatments.
  3. Babies who undergo surgery in the NICU have higher rates of in-hospital death and overall mortality.
  4. For babies on ECMO, the location of the surgery does not significantly affect their chances of survival.
  5. There is no significant difference in the rate of infection at the surgical site between surgeries in the NICU and OR.
  6. Following surgery, babies will continue to be monitored and treated in the NICU until they are stable enough to be discharged.

What to Ask Your Doctor

Some questions a patient should ask their doctor about congenital diaphragmatic hernia repair include:

  1. What are the risks and benefits of having the surgery in the neonatal intensive care unit (NICU) versus the operating room (OR)?
  2. How will the decision of where to perform the surgery be made for my baby?
  3. What experience does the medical team have in performing surgeries for congenital diaphragmatic hernia?
  4. What equipment and resources are available in the NICU for performing the surgery?
  5. How will my baby be monitored during and after the surgery, regardless of the location?
  6. What is the plan for pain management and recovery after the surgery?
  7. How will the location of the surgery impact my baby’s long-term outcomes and quality of life?
  8. Are there any specific precautions or considerations that need to be taken depending on the location of the surgery?
  9. What are the expected outcomes and potential complications associated with the surgical repair for congenital diaphragmatic hernia?
  10. Are there any alternative treatment options or approaches that should be considered?

Reference

Authors: Niec JA, Achey MA, Wallace MW, Patel A, Zhao S, Hatch LD, Morris EA, Danko ME, Pietsch JB, Lovvorn HN. Journal: Am Surg. 2022 Aug;88(8):1814-1821. doi: 10.1177/00031348221084941. Epub 2022 Mar 25. PMID: 35337188