Our Summary

The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative updated their clinical practice guidelines, which were last published in 2018. They reviewed all of the relevant scientific literature from January 2017 to August 2022, in order to make informed changes to their existing guidelines or create new ones.

They started with a review of 3868 articles that covered 15 areas of care for CDH, and did a detailed analysis of 459 of them. Ultimately, they used 103 of these articles to make 20 changes to the existing guidelines. These changes covered things like how to diagnose the condition before birth, how to evaluate it using ultrasound of the heart (echocardiographic evaluation), how to manage high blood pressure in the lungs (pulmonary hypertension), criteria to determine when surgery is needed, what type of surgical repair to use, and how to monitor the long-term health of patients.

They also created 15 new guidelines based on this research. Most of these new guidelines are related to managing pain and providing pain relief and muscle relaxation (analgesia and neuromuscular blockade) for patients with CDH.

In conclusion, this 2023 update to the Canadian CDH Collaborative’s clinical practice guidelines provides a framework for managing infants and children with CDH, based on the latest scientific evidence and expert opinion.

FAQs

  1. What changes were made to the existing CDH care recommendations in the 2023 Canadian CDH Collaborative’s clinical practice guideline update?
  2. What new recommendations were added to the CDH care guidelines in the most recent update?
  3. How were the changes and additions to the CDH care guidelines determined and informed?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to closely follow the post-operative care instructions provided by the medical team. This may include monitoring for signs of infection, ensuring proper wound care, and following up with healthcare providers for regular check-ups and assessments. It is important to communicate any concerns or changes in symptoms to the medical team promptly to ensure the best possible outcome for the patient.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are typically recommended for repair include infants and children who present with respiratory distress, persistent pulmonary hypertension, or other complications related to the hernia. The decision for surgical repair is often based on the severity of the hernia, the presence of associated anomalies, and the overall clinical condition of the patient. In some cases, prenatal diagnosis of CDH may also influence the timing and approach to surgical repair. The updated clinical practice guideline from the Canadian CDH Collaborative provides a comprehensive framework for the management of patients with CDH, incorporating the latest evidence and expert consensus to optimize outcomes for these patients.

Timeline

  • Prenatal diagnosis: The patient may be diagnosed with congenital diaphragmatic hernia during routine prenatal ultrasounds or through other prenatal screening tests.
  • Birth: The patient is born with congenital diaphragmatic hernia and may experience respiratory distress immediately after birth.
  • Evaluation and stabilization: The patient is evaluated by a multidisciplinary team and stabilized in the neonatal intensive care unit (NICU).
  • Surgical repair: The patient undergoes surgical repair of the diaphragmatic hernia to reposition abdominal organs back into the chest cavity and repair the hole in the diaphragm.
  • Post-operative care: The patient receives post-operative care in the NICU, which may include respiratory support, pain management, and monitoring for complications.
  • Long-term follow-up: The patient may require long-term follow-up care to monitor for potential complications such as pulmonary hypertension or developmental delays.

After the congenital diaphragmatic hernia repair, the patient may experience improvements in respiratory function and overall health. However, they may still require ongoing medical care and monitoring to ensure optimal outcomes and address any potential long-term complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with congenital diaphragmatic hernia repair surgery?
  2. How long is the recovery process expected to be after the surgery?
  3. What are the long-term outcomes and potential challenges that may arise post-surgery?
  4. How frequently will follow-up appointments be needed after the surgery?
  5. Are there any specific lifestyle changes or restrictions that should be followed post-surgery?
  6. What signs or symptoms should be monitored for and reported to the healthcare provider post-surgery?
  7. Are there any specific medications or treatments that may be needed after the surgery to manage any potential complications?
  8. What are the chances of the hernia reoccurring after surgery?
  9. What is the expected success rate of the surgery in terms of correcting the hernia?
  10. Are there any alternative treatment options that should be considered before proceeding with surgery?

Reference

Authors: Puligandla P, Skarsgard E, Baird R, Guadagno E, Dimmer A, Ganescu O, Abbasi N, Altit G, Brindle M, Fernandes S, Dakshinamurti S, Flageole H, Hebert A, Keijzer R, Offringa M, Patel D, Ryan G, Traynor M, Zani A, Chiu P; Canadian Congenital Diaphragmatic Hernia Collaborative. Journal: Arch Dis Child Fetal Neonatal Ed. 2024 Apr 18;109(3):239-252. doi: 10.1136/archdischild-2023-325865. PMID: 37879884