Clinical outcomes in congenital diaphragmatic hernia of the fetus

2020 ◽  
pp. 47-53
Author(s):  
G.O. Grebinichenko ◽  
◽  
I.Yu. Gordienko ◽  
O.K. Sliepov ◽  
◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Congenital Diaphragmatic Hernia ◽  
Clinical Outcomes ◽  
Diaphragmatic Hernia ◽  
Postoperative Mortality ◽  
Surgical Correction ◽  
Chromosomal Anomalies ◽  
Surgical Interventions ◽  
Specialized Care ◽  
Prenatal Examination

The objective: to characterize pregnancy course and clinical outcomes for newborns in cases of congenital diaphragmatic hernia, and to compare these data with the results of prenatal examinations Materials and methods. Results of complex prenatal examination of 259 fetuses as patients with diaphragmatic hernia, which were referred to the department of Fetal medicine in 2007–2020, were analyzed. Data on pregnancy course and clinical outcome for infants were collected in 144 cases: from medical records of the Institute (n=77), and by direct survey, if delivery and specialized care took place in other institutions (n=67). The results were compared depending on the clinical outcome and the place of care. Results. Among 144 cases with known outcome, 140 (97.2%) were singleton and 4 (2.8%) were twin pregnancies with only one affected fetus. Termination of pregnancy for fetal anomalies before to 22 weeks was performed in 16.7% (44/144), 83.3% of cases (120/144) ended in childbirth. Before 22 weeks for prenatal examination were referred 30.6% (44/144) of women, of them 54.5% (24/44) have chosen termination in presence of unfavorable prognosis, and in the remaining 45.5% (20/44) cases pregnancy was prolonged. Of the 120 labors, 92.5% were term and 7.5% preterm. Antenatal death after 22 weeks occurred in 4.2% (5/120) cases. Among liveborn infants before surgical correction in the clinics of the Institute have died 25% (18/72), and in other institutions 37.2% (16/43), р>0.05. Postoperative mortality was 13% (7/54) in the Institute and 42.3% (11/26) in other institutions, р=0.0032. The rate of associated pathology was significantly higher among children treated in other institutions (25.6% vs. 5.6%), but the proportion of operated patients did not differ significantly (60.5% in other institutions and 75% in the Institute). Comparison of data of prenatal examination showed significantly higher rate of associated pathology (26.3% vs. 3.2%), polyhydramnios (50.9% vs. 20.6%), right-sided hernia (21.2% vs. 6.3%) and liver herniation in left-sided hernia (81.8% vs. 28.8%) in the group with negative outcome. Conclusions. The majority of pregnancies with diaphragmatic hernia in the fetus ended in childbirth, with high mortality rate. Strategy of complex prenatal examination in cases of congenital diaphragmatic hernia, prognosis evaluation by multidisciplinary council with individualized pregnancy/labor management planning, and delayed surgical correction allow to optimize specialized care and to avoid ineffective surgical interventions in extremely severe clinical and anatomical variants of pathology. Keywords: congenital diaphragmatic hernia, prenatal diagnosis, chromosomal anomalies, congenital malformations, pregnancy, labor.

scholarly journals Anatomical variants of congenital diaphragmatic hernia, their clinical significance and feasibility of prenatal differentiation

2020 ◽  
pp. 19-27
Author(s):  
G.O. Grebinichenko ◽  
◽  
I.Y. Gordienko ◽  
O.K. Sliepov ◽  
A.O. Zhuravel ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Clinical Outcomes ◽  
Diaphragmatic Hernia ◽  
Total Mortality ◽  
Postoperative Mortality ◽  
Bilateral Hernia ◽  
Anatomical Variants ◽  
Liver Herniation ◽  
The Difference ◽  
Significant Patterns

Purpose — to present verified typical anatomical variants of isolated congenital diaphragmatic hernia and clinical outcomes in newborns depending on the type of pathology, to compare with data of prenatal examination, and to assess feasibility of prenatal differentiation of congenital diaphragmatic hernia. Materials and methods. The data of operation protocols and autopsy results of newborn patients with isolated congenital diaphragmatic hernia for the period 2007–2020 were analyzed, and then compared with prenatal exam data and clinical outcomes. Data from different anatomical variants of congenital diaphragmatic hernia were analyzed using descriptive statistics methods. Results. Anatomical data were evaluated in 67 cases with the following typical variants: left-sided non-communicating defect (20.9%), left-sided communicating with herniation of intestine (19.4%), intestine and stomach (26,9%), intestine, stomach and liver (19.4%, 13/67), right- sided communicating with intestine and liver herniation (10.4%), right- sided non-communicating (1.5%), bilateral communicating defects (1.5%). Mortality at the stage of stabilization in these variants was 0%, 0%, 11.1%, 30.8%, 71.4%, 0% and 100%, postoperative mortality, respectively, 7.1%, 0%, 12.5%, 44.4%, 0%, 0% (excluding bilateral hernia), total mortality 7.1%, 0%, 22.2%, 61.5%, 71.4%, 0%, 100%. Comparison of lung indices in patients with left-sided hernias showed their similarity in groups with non-communicating defects and communicating with herniation of intestine. Significant differences were found in the groups with herniation of the intestine and stomach, and intestines, stomach and liver. The mean liver-to-lung ratio in right-sided communicating defects was 3.7±1.9, in left-sided communicating defects 1.7±0.8 and in non-communicating 0.44±0.25, the difference between all groups was highly significant. Patterns of stomach position in different variants of pathology were determined. Conclusions. Analysis of postnatally verified cases of diaphragmatic hernia showed marked anatomical variability. The highest mortality and the lowest rate of surgical correction registered was in communicating right-sided defects, and in communicating left-sided with simultaneous herniation of the intestine, stomach and liver. The best outcomes were found in non-communicating defects, or in communicating with herniation of intestine. Prenatal evaluation of stomach position may be the basis to differentiation between clinico-anatomical variants of the pathology. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the Institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital diaphragmatic hernia, congenital malformations, prenatal diagnosis.

Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention

Neonatology ◽  
2017 ◽  
Vol 112 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Eva Van Ginderdeuren ◽  
Karel Allegaert ◽  
Herbert Decaluwe ◽  
Jan Deprest ◽  
Anne Debeer ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Intervention

scholarly journals Deformity and Clinical Outcomes Following Surgical Correction of Charcot Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0043
Author(s):  
Stephen Wallace ◽  
Tomas E. Liskutin ◽  
Adam P. Schiff ◽  
Michael S. Pinzur
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Ankle Joint ◽  
Chronic Wounds ◽  
Surgical Techniques ◽  
Lessons Learned ◽  
Surgical Correction ◽  
Surgical Reconstruction ◽  
Charcot Foot ◽  
Therapeutic Footwear

Category: Ankle, Ankle Arthritis, Diabetes, Hindfoot, Trauma Introduction/Purpose: Deformity associated with Charcot Foot Arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following surgical correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot Foot Arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent surgical reconstruction of Charcot Foot deformity involving the ankle joint by a single surgeon over a fourteen year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between preoperative or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusion: Surgical correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly co-morbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques.

scholarly journals Difficult Journey from Delivery to Discharge, Case of Congenital Diaphragmatic Hernia

2015 ◽  
Vol 12 (2) ◽  
pp. 149-150
Author(s):  
RM Karmacharya ◽  
S Dangol ◽  
M Shrestha ◽  
R Koju
Keyword(s):  
Medical Journal ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Surgical Correction

We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient.Kathmandu University Medical Journal Vol.12(2) 2014: 149-150

scholarly journals Likely damaging de novo variants in congenital diaphragmatic hernia patients are associated with worse clinical outcomes

2020 ◽  
Vol 22 (12) ◽  
pp. 2020-2028 ◽  
Author(s):  
Lu Qiao ◽  
Julia Wynn ◽  
Lan Yu ◽  
Rebecca Hernan ◽  
Xueya Zhou ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Clinical Outcomes ◽  
Diaphragmatic Hernia ◽  
De Novo
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