Eur J Pediatr Surg 2016; 26(01): 038-046
DOI: 10.1055/s-0035-1564713
Original Article
Georg Thieme Verlag KG Stuttgart · New York

International Survey on the Management of Congenital Diaphragmatic Hernia

Augusto Zani
1   Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Paediatric Surgery, Sapienza University of Rome, Rome, Italy
,
Simon Eaton
3   Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom
,
Prem Puri
4   Department of Paediatric Surgery, National Children's Research Centre, Dublin, Ireland
,
Risto Rintala
5   Department of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland
,
Marija Lukac
6   Department of Pediatric Surgery, Faculty of Medicine, Belgrade, Serbia
7   Department of Neonatal Surgery, University Children's Hospital, Belgrade, Serbia
,
Pietro Bagolan
8   Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
,
Joachim F. Kuebler
9   Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
,
Florian Friedmacher
10   Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
,
Michael E. Hoellwarth
10   Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
,
Rene Wijnen
11   Department of Pediatric Surgery, Sophia Children's Hospital, ErasmusMC, Rotterdam, The Netherlands
,
Juan A. Tovar
12   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Agostino Pierro
1   Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
3   Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom
,
on behalf of the EUPSA Network Office › Author Affiliations
Further Information

Publication History

25 May 2015

15 July 2015

Publication Date:
14 October 2015 (online)

Abstract

Aim This study aims to define patterns in the management of congenital diaphragmatic hernia (CDH).

Methods A total of 180 delegates (77% senior surgeons) from 44 (26 European) countries completed a survey at the 2014 European Pediatric Surgeons' Association meeting.

Results Overall, 34% of the surgeons work in centers that treat < 5 cases of CDH/y, 38% work in centers that treat 5 to 10 cases/y, and 28% work in centers that treat > 10 cases/y. Overall, 62% of the surgeons work in extra corporeal membrane oxygenation (ECMO) centers and 23% in fetal surgery centers. Prenatal work up and delivery: 47% surgeons request prenatal magnetic resonance imaging, 53% offer karyotyping, 22% perform a fetal intervention, 74% monitor head-to-lung ratio, and 55% administer maternal steroids. Delivery is via cesarean section for 47% surgeons, at 36 to 38 weeks for 71% surgeons, and in a tertiary care center for 94% of the surgeons.

Postnatal Management A total of 76% surgeons report elective intubation, 65% start antibiotics preoperatively, and 45% administer surfactant. In case of refractory hypoxia, 66% surgeons consider ECMO with a variable course. Parenteral feeding is started preoperatively by 56% of the surgeons. Only 13% of the surgeons request contrast studies preoperatively to rule out malrotation.

 
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