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Congenital diaphragmatic hernia: a survey of practice in Scandinavia

Skari, H; Bjornland, K; Frenckner, B; Friberg, LG; Heikkinen, M; Hurme, T; Loe, B; Mollerlokken, G; Nielsen, OH and Qvist, N, et al. (2004) In Pediatric Surgery International 20(5). p.309-313
Abstract
There is no consensus on the treatment of congenital diaphragmatic hernia (CDH), and practice seems to vary between centres. The main purpose of the present study was to survey current practice in Scandinavia. Thirteen paediatric surgical centres serving a population of about 22 million were invited, and all participated. One questionnaire was completed at each centre. The questionnaire evaluated management following prenatal diagnosis, intensive care strategies, operative treatment, and long-term follow-up. Survival data (1995-1998) were available from 12 of 13 centres. Following prenatal diagnosis of CDH, vaginal delivery and maternal steroids were used at eight and six centres, respectively. All centres used high-frequency oscillation... (More)
There is no consensus on the treatment of congenital diaphragmatic hernia (CDH), and practice seems to vary between centres. The main purpose of the present study was to survey current practice in Scandinavia. Thirteen paediatric surgical centres serving a population of about 22 million were invited, and all participated. One questionnaire was completed at each centre. The questionnaire evaluated management following prenatal diagnosis, intensive care strategies, operative treatment, and long-term follow-up. Survival data (1995-1998) were available from 12 of 13 centres. Following prenatal diagnosis of CDH, vaginal delivery and maternal steroids were used at eight and six centres, respectively. All centres used high-frequency oscillation ventilation (HFOV), nitric oxide (NO), and surfactant comparatively often. Five centres had extracorporeal membrane oxygenation (ECMO) facilities, and four centres transferred ECMO candidates. The majority of centres (7/9) always tried HFOV before ECMO was instituted. Surgery was performed when the neonate was clinically stable (11/13) and when no signs of pulmonary hypertension were detected by echo-Doppler (6/13). The repair was performed by laparotomy at all centres and most commonly with nonabsorbable sutures (8/13). Thoracic drain was used routinely at seven centres. Long-term follow-up at a paediatric surgical centre was uncommon (3/13). Only three centres treated more than five CDH patients per year. Comparing survival in centres treating more than five with those treating five or fewer CDH patients per year, there was a tendency towards better survival in the higher-volume centres (72.4%) than in the centres with lower volume (58.7%), p =0.065. (Less)
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keywords
high-frequency oscillation ventilation, congenital diaphragmatic hernia, extracorporeal membrane oxygenation, mode of delivery, prenatal, diagnosis
in
Pediatric Surgery International
volume
20
issue
5
pages
309 - 313
publisher
Springer
external identifiers
  • pmid:15156335
  • wos:000222513800001
  • scopus:3242713243
ISSN
1437-9813
DOI
10.1007/s00383-004-1186-7
language
English
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d2c8e2cf-ec44-406e-beb3-5cb41e4088c8 (old id 273138)
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2007-10-26 14:21:58
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2017-04-23 04:24:11
@article{d2c8e2cf-ec44-406e-beb3-5cb41e4088c8,
  abstract     = {There is no consensus on the treatment of congenital diaphragmatic hernia (CDH), and practice seems to vary between centres. The main purpose of the present study was to survey current practice in Scandinavia. Thirteen paediatric surgical centres serving a population of about 22 million were invited, and all participated. One questionnaire was completed at each centre. The questionnaire evaluated management following prenatal diagnosis, intensive care strategies, operative treatment, and long-term follow-up. Survival data (1995-1998) were available from 12 of 13 centres. Following prenatal diagnosis of CDH, vaginal delivery and maternal steroids were used at eight and six centres, respectively. All centres used high-frequency oscillation ventilation (HFOV), nitric oxide (NO), and surfactant comparatively often. Five centres had extracorporeal membrane oxygenation (ECMO) facilities, and four centres transferred ECMO candidates. The majority of centres (7/9) always tried HFOV before ECMO was instituted. Surgery was performed when the neonate was clinically stable (11/13) and when no signs of pulmonary hypertension were detected by echo-Doppler (6/13). The repair was performed by laparotomy at all centres and most commonly with nonabsorbable sutures (8/13). Thoracic drain was used routinely at seven centres. Long-term follow-up at a paediatric surgical centre was uncommon (3/13). Only three centres treated more than five CDH patients per year. Comparing survival in centres treating more than five with those treating five or fewer CDH patients per year, there was a tendency towards better survival in the higher-volume centres (72.4%) than in the centres with lower volume (58.7%), p =0.065.},
  author       = {Skari, H and Bjornland, K and Frenckner, B and Friberg, LG and Heikkinen, M and Hurme, T and Loe, B and Mollerlokken, G and Nielsen, OH and Qvist, N and Rintala, R and Sandgren, Katarina and Serlo, W and Wagner, K and Wester, T and Emblem, R},
  issn         = {1437-9813},
  keyword      = {high-frequency oscillation ventilation,congenital diaphragmatic hernia,extracorporeal membrane oxygenation,mode of delivery,prenatal,diagnosis},
  language     = {eng},
  number       = {5},
  pages        = {309--313},
  publisher    = {Springer},
  series       = {Pediatric Surgery International},
  title        = {Congenital diaphragmatic hernia: a survey of practice in Scandinavia},
  url          = {http://dx.doi.org/10.1007/s00383-004-1186-7},
  volume       = {20},
  year         = {2004},
}