Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization

Kouji Masumoto, Risa Teshiba, Genshiro Esumi, Kouji Nagata, Yasushi Takahata, Shunji Hikino, Toshiro Hara, Satoshi Hojo, Kiyomi Tsukimori, Norio Wake, Naoko Kinukawa, Tomoaki Taguchi

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background/Objectives: No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient's circulatory stabilization (CS) was achieved. Patients and methods: This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T, <0.10) was further investigated in both groups. Results: The overall survival rate (SR) was 93.8% in the GV + CS group and 59.1% in the FS group, respectively (P = 0.04). For the patients with the lower L/T, the SR was 85.7% in GV + CS group and 53.8% in the FS group (P = 0.33). Regarding the patients using a patch and liver-up, the SR in GV + CS group was better than that in the FS group (patch: FS 44.4%, GV ± CS 87.5%, P = 0.18; liver-up: FS 57.8 and 87.5%, P = 0.30). Conclusion: Our strategy of using GV ± CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients.

Original languageEnglish
Pages (from-to)487-492
Number of pages6
JournalPediatric Surgery International
Volume25
Issue number6
DOIs
Publication statusPublished - Jun 1 2009

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Ventilation
Survival Rate
Liver
Congenital Diaphragmatic Hernias
Diazepam
Cesarean Section
Morphine
Placenta
Fetus
Thorax
Lung
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization. / Masumoto, Kouji; Teshiba, Risa; Esumi, Genshiro; Nagata, Kouji; Takahata, Yasushi; Hikino, Shunji; Hara, Toshiro; Hojo, Satoshi; Tsukimori, Kiyomi; Wake, Norio; Kinukawa, Naoko; Taguchi, Tomoaki.

In: Pediatric Surgery International, Vol. 25, No. 6, 01.06.2009, p. 487-492.

Research output: Contribution to journalArticle

Masumoto, K, Teshiba, R, Esumi, G, Nagata, K, Takahata, Y, Hikino, S, Hara, T, Hojo, S, Tsukimori, K, Wake, N, Kinukawa, N & Taguchi, T 2009, 'Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization', Pediatric Surgery International, vol. 25, no. 6, pp. 487-492. https://doi.org/10.1007/s00383-009-2370-6
Masumoto, Kouji ; Teshiba, Risa ; Esumi, Genshiro ; Nagata, Kouji ; Takahata, Yasushi ; Hikino, Shunji ; Hara, Toshiro ; Hojo, Satoshi ; Tsukimori, Kiyomi ; Wake, Norio ; Kinukawa, Naoko ; Taguchi, Tomoaki. / Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization. In: Pediatric Surgery International. 2009 ; Vol. 25, No. 6. pp. 487-492.
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abstract = "Background/Objectives: No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient's circulatory stabilization (CS) was achieved. Patients and methods: This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T, <0.10) was further investigated in both groups. Results: The overall survival rate (SR) was 93.8{\%} in the GV + CS group and 59.1{\%} in the FS group, respectively (P = 0.04). For the patients with the lower L/T, the SR was 85.7{\%} in GV + CS group and 53.8{\%} in the FS group (P = 0.33). Regarding the patients using a patch and liver-up, the SR in GV + CS group was better than that in the FS group (patch: FS 44.4{\%}, GV ± CS 87.5{\%}, P = 0.18; liver-up: FS 57.8 and 87.5{\%}, P = 0.30). Conclusion: Our strategy of using GV ± CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients.",
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T1 - Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization

AU - Masumoto, Kouji

AU - Teshiba, Risa

AU - Esumi, Genshiro

AU - Nagata, Kouji

AU - Takahata, Yasushi

AU - Hikino, Shunji

AU - Hara, Toshiro

AU - Hojo, Satoshi

AU - Tsukimori, Kiyomi

AU - Wake, Norio

AU - Kinukawa, Naoko

AU - Taguchi, Tomoaki

PY - 2009/6/1

Y1 - 2009/6/1

N2 - Background/Objectives: No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient's circulatory stabilization (CS) was achieved. Patients and methods: This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T, <0.10) was further investigated in both groups. Results: The overall survival rate (SR) was 93.8% in the GV + CS group and 59.1% in the FS group, respectively (P = 0.04). For the patients with the lower L/T, the SR was 85.7% in GV + CS group and 53.8% in the FS group (P = 0.33). Regarding the patients using a patch and liver-up, the SR in GV + CS group was better than that in the FS group (patch: FS 44.4%, GV ± CS 87.5%, P = 0.18; liver-up: FS 57.8 and 87.5%, P = 0.30). Conclusion: Our strategy of using GV ± CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients.

AB - Background/Objectives: No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient's circulatory stabilization (CS) was achieved. Patients and methods: This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T, <0.10) was further investigated in both groups. Results: The overall survival rate (SR) was 93.8% in the GV + CS group and 59.1% in the FS group, respectively (P = 0.04). For the patients with the lower L/T, the SR was 85.7% in GV + CS group and 53.8% in the FS group (P = 0.33). Regarding the patients using a patch and liver-up, the SR in GV + CS group was better than that in the FS group (patch: FS 44.4%, GV ± CS 87.5%, P = 0.18; liver-up: FS 57.8 and 87.5%, P = 0.30). Conclusion: Our strategy of using GV ± CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients.

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