Our Summary

The research paper revolves around the treatment of newborns with a birth defect known as congenital diaphragmatic hernia (CDH), where the diaphragm doesn’t develop properly. This condition can have several complications, one of which is the formation of blood clots in the vena cava, the body’s largest vein.

The researchers looked back at the medical records of all the newborns who underwent CDH repair in their department from 2007 to 2021, specifically focusing on incidents of vena cava blood clots. These clots were identified using ultrasound and were categorized as either fully or partially blocking the vein.

Out of 57 newborns who had CDH repair, 14 (around 25%) were found to have vena cava blood clots. Factors that were linked to these blood clots were the use of a certain type of vein catheter, the CDH being on the right side, and a condition called chylothorax (a type of fluid accumulation in the chest). However, a life-supporting treatment called ECMO was not linked to these blood clots.

Half of the patients with vena cava blood clots were treated with a procedure to widen the blocked vein; the other half were treated with blood thinners only. The researchers found that the mortality rate wasn’t higher in patients with vena cava blood clots compared to those without.

The researchers concluded that the risk of vena cava blood clots in newborns with CDH is high, so routine ultrasound scans focusing on the vena cava are essential after CDH repair. They also noted that patients who developed these blood clots were more likely to develop chylothorax after CDH repair. Given the success of medical therapy in treating partial vena cava blood clots, they suggested that all newborns with CDH could potentially be given low doses of blood thinners.

FAQs

  1. What is the incidence rate of vena cava thrombosis in newborns with congenital diaphragmatic hernia (CDH)?
  2. What factors are associated with vena cava thrombosis in newborns with CDH?
  3. What treatment options are available for vena cava thrombosis in newborns with CDH?

Doctor’s Tip

A helpful tip a doctor might give a patient about congenital diaphragmatic hernia repair is to be aware of the possibility of vena cava thrombosis as a potential complication after surgery. It is important for patients to be vigilant for symptoms such as swelling, pain, or discoloration in the legs, as these could be signs of a blood clot in the vena cava. Patients should follow up closely with their healthcare provider for monitoring and potential intervention if vena cava thrombosis is suspected. Routine postoperative abdominal sonography focusing on vena cava thrombosis may be recommended for all patients undergoing CDH repair. Additionally, patients with certain risk factors such as femoral or saphenous venous catheter, right-sided CDH, or chylothorax should be monitored closely for vena cava thrombosis.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are typically recommended for repair include newborns who present with respiratory distress shortly after birth, have a confirmed diagnosis of CDH through imaging studies, and have stable hemodynamics. Additionally, patients with CDH who have associated complications such as pulmonary hypertension, cardiac anomalies, or other comorbidities may also be recommended for repair. It is important for these patients to undergo timely surgical intervention to correct the hernia and prevent further complications.

Timeline

  • Before congenital diaphragmatic hernia (CDH) repair:
  1. Patient is diagnosed with CDH either prenatally or shortly after birth through imaging studies.
  2. Patient may experience respiratory distress and difficulty breathing due to the herniated organs compressing the lungs.
  3. Patient may undergo stabilization and treatment in the neonatal intensive care unit (NICU) to improve respiratory function.
  4. Patient may receive supportive care such as mechanical ventilation or extracorporeal membrane oxygenation (ECMO) if needed.
  5. Patient may undergo preoperative evaluations and consultations with a multidisciplinary team including surgeons, neonatologists, and anesthesiologists.
  • After CDH repair:
  1. Patient undergoes surgical repair of the diaphragmatic hernia to reposition the abdominal organs back into the abdomen and close the defect.
  2. Patient may require postoperative monitoring in the NICU for respiratory support and management of potential complications.
  3. Patient may undergo follow-up imaging studies to assess the success of the repair and monitor for any complications.
  4. Patient may receive physical therapy and rehabilitation to aid in recovery and improve lung function.
  5. Patient may be discharged home once stable and continue to follow up with healthcare providers for long-term monitoring and management of any potential complications related to CDH repair.

What to Ask Your Doctor

  1. What is the likelihood of my baby developing vena cava thrombosis after CDH repair?
  2. What are the risk factors for vena cava thrombosis in newborns with CDH?
  3. How is vena cava thrombosis diagnosed and monitored in newborns with CDH?
  4. What are the potential treatment options for vena cava thrombosis in newborns with CDH?
  5. Will my baby need any specific follow-up or monitoring for vena cava thrombosis after CDH repair?
  6. How does the presence of vena cava thrombosis affect my baby’s overall prognosis and recovery after CDH repair?
  7. Are there any preventive measures or interventions that can help reduce the risk of vena cava thrombosis in newborns with CDH?
  8. How will the presence of vena cava thrombosis impact my baby’s long-term health and development?

Reference

Authors: Kiblawi R, Zoeller C, Pirr S, Hofmann AD, Ure B, Dingemann J. Journal: Eur J Pediatr Surg. 2022 Feb;32(1):91-97. doi: 10.1055/s-0041-1740462. Epub 2021 Dec 10. PMID: 34891190