Congenital diaphragmatic hernia: Exclusion criteria for repair or ECMO?
| Title: | Congenital diaphragmatic hernia: Exclusion criteria for repair or ECMO? |
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| Authors: | Yang MJ; Department of Pediatrics/Neonatology, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA. Electronic address: michelle.yang@hsc.utah.edu.; Yost CC; Department of Pediatrics/Neonatology, Intermountain Health, Salt Lake City, UT, USA; Molecular Medicine Program, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.; Carpenter RJ; Department of Pediatrics/Neonatology, Intermountain Health, Salt Lake City, UT, USA; Division of Pediatric Cardiology, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.; Kahan AM; Division of Pediatric Surgery, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.; Fenton SJ; Division of Pediatric Surgery, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.; Russell KW; Division of Pediatric Surgery, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA.; Yoder BA; Department of Pediatrics/Neonatology, Intermountain Health, Salt Lake City, UT, USA; University of Utah School of Medicine and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA. |
| Source: | Journal of pediatric surgery [J Pediatr Surg] 2025 Oct 09, pp. 162721. Date of Electronic Publication: 2025 Oct 09. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Saunders Country of Publication: United States NLM ID: 0052631 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-5037 (Electronic) Linking ISSN: 00223468 NLM ISO Abbreviation: J Pediatr Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: Philadelphia, PA : Saunders; Original Publication: New York. |
| Abstract: | Background: Mortality in congenital diaphragmatic hernia (CDH) approximates 30 %. Both severe lung hypoplasia and other anomalies contribute to demise regardless of repair and/or extracorporeal membrane oxygenation (ECMO). We report clinical and physiological parameters for CDH infants not offered repair or ECMO (NoR/ECMO).; Methods: A single center retrospective analysis of 364 CDH infants managed from 01/2003 - 12/2024. We analyzed reasonings to not offer repair or ECMO in 49 infants (13 %) across two time epochs. We compared the outcomes of infants that did or did not meet 3 possible lethal lung hypoplasia criteria based on maximum SpO2 and minimum paCO2 in the first 24 h of life.; Results: Concurrent anomalies (n = 27, 55 %), prematurity 75 mmHg; none were offered ECMO or repair. Another 15 infants met one or the other criteria; 4 were offered ECMO and repair with no survivors.; Conclusion: In our center, severe concurrent anomalies, prematurity, and severe lung hypoplasia accounted for 90 % of all CDH infants not offered repair or ECMO. Failure to achieve either SpO2 ≥ 85 % and/or paCO2 ≤ 75 mmHg within the first 24 h of life despite optimal medical management was uncommon but consistent with lethal lung hypoplasia.; (Copyright © 2025 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Conflicts of interest C.C.Y. is the author of a US patent (patent number 10,232,023 B2) held by The University of Utah for the use of neutrophil extracellular trap-inhibitory peptides for the “treatment of and prophylaxis against inflammatory disorders”. The remaining authors declare no competing financial interests. |
| Contributed Indexing: | Keywords: Congenital diaphragmatic hernia; ECMO; Lung hypoplasia; Neonate; Surgical repair; Survival |
| Entry Date(s): | Date Created: 20251009 Latest Revision: 20251017 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.jpedsurg.2025.162721 |
| PMID: | 41067518 |
| Database: | MEDLINE |
Journal Article