Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8009766/

  Congenital diaphragmatic hernia (CDH), a severe birth defect characterized by a diaphragmatic malformation allowing herniation by abdominal organs into the thorax, is associated with high mortality. […] The purpose of our study was to examine (1) the overall CDH prevalence and (2) mortality and survival trends of infants with CDH using data collected by hospital- and population-based birth defects surveillance programs from multiple countries affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). […] Overall, the prevalence of CDH from all countries combined was 2.6 per 10,000 total births (95% CI: 2.52.7), slightly increasing between 2001 and 2012 (average annual percent change [AAPC]=0.47%). […] The overall percent mortality of CDH was 37.7%, with hospital-based registries having more deaths involving live births than population-based registries (45.1% compared to 33.8%).

• #1 Overview of Epidemiology, Genetics, Birth Defects, and Chromosome Abnormalities Associated With CDH

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2891729/

  Congenital diaphragmatic hernia (CDH) is a common and well-studied birth defect. The etiology of most cases remains unknown but increasing evidence points to genetic causation. […] CDH is a common birth defect that is associated with considerable morbidity and mortality. A discussion of epidemiology of CDH is complicated by lack of uniform data collection methods as some studies are population-based, capturing all CDH cases detected early in pregnancy, while others are tertiary-care based capturing only CDH patients who survive delivery and subsequent referral to a specialty center. This discrepancy reveals the hidden mortality of CDH, a concept first introduced by Dr. Michael Harrison in 1978. […] The average prevalence of CDH, derived from a meta-analysis of 16 population-based studies, was 1/4000 births.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8009766/

  Mortality rates decreased over time (AAPC=2.43%). […] The prevalence of CDH has increased over time; although the mortality rate has slightly decreased, it remains high especially during the first week of life and varied by registry type. […] Worldwide, CDH occurs in approximately 1 in every 3,000 live births. […] Approximately 64% of CDH cases are isolated and 36% have multiple anomalies. […] Infants with CDH have significant morbidity and mortality, with a mortality rate between 30% and 60% or as high as 89% when additional chromosomal or structural anomalies are present. […] The overall mortality for the first 24 hours of life was 7.4% and for the first week of life was 26.4%. […] The cumulative 5-year mortality rate was 37.7% overall. The cumulative 5-year mortality rate was 45.1% among hospital-based registries and 33.8% among population-based registries.

• #2 Overview of Epidemiology, Genetics, Birth Defects, and Chromosome Abnormalities Associated With CDH

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2891729/

  Congenital diaphragmatic hernia (CDH) is a common and well-studied birth defect. The etiology of most cases remains unknown but increasing evidence points to genetic causation. […] CDH is a common birth defect that is associated with considerable morbidity and mortality. A discussion of epidemiology of CDH is complicated by lack of uniform data collection methods as some studies are population-based, capturing all CDH cases detected early in pregnancy, while others are tertiary-care based capturing only CDH patients who survive delivery and subsequent referral to a specialty center. This discrepancy reveals the hidden mortality of CDH, a concept first introduced by Dr. Michael Harrison in 1978. […] The average prevalence of CDH, derived from a meta-analysis of 16 population-based studies, was 1/4000 births.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8009766/

  Congenital diaphragmatic hernia (CDH), a severe birth defect characterized by a diaphragmatic malformation allowing herniation by abdominal organs into the thorax, is associated with high mortality. […] The purpose of our study was to examine (1) the overall CDH prevalence and (2) mortality and survival trends of infants with CDH using data collected by hospital- and population-based birth defects surveillance programs from multiple countries affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). […] Overall, the prevalence of CDH from all countries combined was 2.6 per 10,000 total births (95% CI: 2.52.7), slightly increasing between 2001 and 2012 (average annual percent change [AAPC]=0.47%). […] The overall percent mortality of CDH was 37.7%, with hospital-based registries having more deaths involving live births than population-based registries (45.1% compared to 33.8%).

• #2 Overview of Epidemiology, Genetics, Birth Defects, and Chromosome Abnormalities Associated With CDH

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2891729/

  All studies demonstrate that infants with complex CDH have a higher mortality than those with isolated CDH. […] A meta-analysis published in 2000 found that the average mortality for cases ascertained prenatally was 75%, for cases ascertained as part of a population-based study was 48%, while for those cases transferred to a treatment center was 45%. […] Two recent population-based studies continue to find overall mortality remains greater than 50-60%, despite the introduction of new therapies such as ECMO.

• #3 The etiology of congenital diaphragmatic hernia: the retinoid hypothesis 20 years later | Pediatric Research

  https://www.nature.com/articles/s41390-023-02905-7

  Congenital diaphragmatic hernia (CDH) is a severe birth defect and a major cause of neonatal respiratory distress. Impacting ~23 in 10,000 births, CDH is associated with a high mortality rate, and long-term morbidity in survivors. […] The etiology of CDH is complex and remains largely unknown. […] Approximately 30-40% of CDH cases have an identifiable genetic cause. […] Environmental risk factors for CDH are varied, including associations with maternal age, alcohol use, and smoking. […] One of the leading hypotheses to explain the etiology of CDH is the so-called Retinoid Hypothesis. […] The Retinoid Hypothesis was based on research dating back to the 1940s, drawing together several threads of evidence to justify the notion that altered retinoid signaling may cause CDH. […] The Retinoid Hypothesis is one of the leading hypotheses to explain the etiology of CDH, as we continue to better understand the role of retinoid signaling in diaphragm development.

• #4 Congenital diaphragmatic hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/congenital-diaphragmatic-hernia-1?embed_domain=external.radpair.com&lang=gb

  Congenital diaphragmatic hernias are seen in 1 of every 2000-4000 live births. 84% are left-sided, 13% are right-sided and 2% bilateral. […] Congenital diaphragmatic herniation (CDH) accounts for a small proportion of all diaphragmatic herniae. However, it is one of the most common non-cardiac fetal intrathoracic anomalies.

• #5

  https://stacks.cdc.gov/view/cdc/104769

  Importance Congenital diaphragmatic hernia (CDH), a severe birth defect characterized by a diaphragmatic malformation allowing herniation by abdominal organs into the thorax, is associated with high mortality. […] The purpose of our study was to examine (1) the overall CDH prevalence and (2) mortality and survival trends of infants with CDH using data collected by hospital- and population-based birth defects surveillance programs from multiple countries affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). […] Overall, the prevalence of CDH from all countries combined was 2.6 per 10,000 total births (95% CI: 2.52.7), slightly increasing between 2001 and 2012 (average annual percent change [AAPC]=0.47%). […] The overall percent mortality of CDH was 37.7%, with hospital-based registries having more deaths involving live births than population-based registries (45.1% compared to 33.8%).

• #5

  https://stacks.cdc.gov/view/cdc/104769

  Mortality rates decreased over time (AAPC=2.43%). […] Most deaths due to CDH occurred among 2- to 6-day-old infants for both registry types (36.3%, hospital-based; 12.1%, population-based). […] The prevalence of CDH has increased over time; although the mortality rate has slightly decreased, it remains high especially during the first week of life and varied by registry type. Further research is needed to inform development of measures and interventions to decrease deaths among infants with CDH.

• #6

  https://link.springer.com/article/10.1007/s12519-023-00774-y

  The prevalence of congenital diaphragmatic hernia (CDH) varies across countries, with limited information available on its epidemiology in China. Our study aimed to investigate the prevalence, time trends, and perinatal outcomes of CDH in China, as well as its associated malformations and potential associations with maternal and infant characteristics. […] A total of 4397 CDH cases were identified among 24,158,029 births in the study period, yielding prevalence rates of 1.82, 1.13 and 0.69 per 10,000 for overall, isolated, and associated CDH, respectively. The prevalence of each type of CDH increased over time. […] The increasing prevalence and high perinatal mortality rate of CDH highlight the need for further etiological, epidemiological, and clinical studies among the Chinese population.

• #7 Epidemiology of congenital diaphragmatic hernia among 24 million Chinese births: a hospital-based surveillance study | springermedizin.de

  https://www.springermedizin.de/epidemiology-of-congenital-diaphragmatic-hernia-among-24-million/26510358

  The prevalence of congenital diaphragmatic hernia (CDH) varies across countries, with limited information available on its epidemiology in China. Our study aimed to investigate the prevalence, time trends, and perinatal outcomes of CDH in China, as well as its associated malformations and potential associations with maternal and infant characteristics. […] A total of 4397 CDH cases were identified among 24,158,029 births in the study period, yielding prevalence rates of 1.82, 1.13 and 0.69 per 10,000 for overall, isolated, and associated CDH, respectively. The prevalence of each type of CDH increased over time. […] The increasing prevalence and high perinatal mortality rate of CDH highlight the need for further etiological, epidemiological, and clinical studies among the Chinese population.

• #7 Epidemiology of congenital diaphragmatic hernia among 24 million Chinese births: a hospital-based surveillance study | springermedizin.de

  https://www.springermedizin.de/epidemiology-of-congenital-diaphragmatic-hernia-among-24-million/26510358

  Our study found that the prevalence of CDH was 1.82 per 10,000 births and showed an increasing trend over time. Higher prevalence rates were observed among male fetuses, older mothers, and mothers residing in urban areas, particularly in the eastern and central regions. Additionally, infants with associated CDH had a higher risk of premature birth and perinatal death compared to those with isolated CDH. […] The rising trend of CDH prevalence in China may be attributed to improvements in prenatal diagnosis, including better and more accessible ultrasonography. Changes in maternal environmental exposures and other factors associated with CDH may also contribute to the increasing trend. […] Our study showed a higher risk of CDH among older mothers, consistent with previous studies.

• #8

  https://journals.lww.com/sjmm/fulltext/2013/01020/epidemiology_and_outcome_of_congenital.6.aspx

  Congenital diaphragmatic hernia (CDH) is a major birth defect, which continues to be associated with significant rate of morbidity and mortality. […] The incidence of CDH among the inborn infants was 1/250 live births (P 0.05) and the overall male to female ratio was 0.7. […] The incidence of CDH was found much higher than the reported cases in literature; and although the mortality rate has improved after the introduction of iNO, the difference was not statistically significant. […] Nationally and in the Kingdom of Saudi Arabia, the number of hospital experiences is limited and doesn’t serve as an appropriate reference for the local data base. […] The prognosis of CDH depends upon the many factors. […] The reported incidence of right-sided CDH is about 20% while in our study was 7%; it carries a worse prognosis because of liver herniation into the chest cavity. […] Despite the ongoing advancement in neonatal-perinatal medicine, CDH remains a serious condition and its rate of morbidity and mortality remains fairly high.

• #9

  https://consensus.app/questions/show-scholarly-articles-discussing-incidence-congenital/

  Congenital diaphragmatic hernia (CDH) is a severe congenital malformation characterized by an abnormal opening in the diaphragm, allowing abdominal organs to move into the chest cavity, which can lead to significant respiratory distress and other complications. The global prevalence of CDH is approximately 2.3 per 10,000 live births, based on a systematic review of population-based epidemiological studies. This prevalence can vary significantly across different geographical regions, highlighting the need for more comprehensive global studies to better understand the distribution of CDH. […] In the United States, a population-based study of over 32 million births reported an incidence of 1.93 per 10,000 births. Another study indicated that the incidence of CDH can range from 1.7 to 5.7 per 10,000 live births, depending on the study population. These variations underscore the importance of regional data in understanding the true incidence of CDH.

• #9

  https://consensus.app/questions/show-scholarly-articles-discussing-incidence-congenital/

  The overall mortality rate for CDH remains high, with studies reporting mortality rates of over 60%. However, there has been a decrease in mortality over time, particularly in high-volume centers and with advancements in medical care. Despite these improvements, long-term morbidity remains significant, with survivors often facing chronic respiratory issues, neurodevelopmental problems, and other health challenges. […] Congenital diaphragmatic hernia is a complex condition with a significant impact on affected infants and their families. While the global prevalence is relatively low, the associated morbidity and mortality are substantial. Understanding the risk factors and associated conditions can help in early diagnosis and management, potentially improving outcomes for these infants. Further research is needed to explore the genetic and environmental factors contributing to CDH and to develop more effective treatment strategies.

• #10 Congenital Diaphragmatic Hernia | Thoracic Key

  https://thoracickey.com/congenital-diaphragmatic-hernia/

  A CDH occurs in an overall incidence ranging from 1 in 2000 to 4000 live births. The baby is usually mature, and two thirds of affected infants are male. About 95% of CDHs occur on the left side through the Bochdalek foramen. The mortality rate is about 40%. The prognosis depends on (1) the size of the defect, (2) the degree of hypoplasia, (3) the condition of the lung on the unaffected side, and (4) the success of the surgical diaphragmatic closure. […] The following clinical manifestations result from the pathologic mechanisms caused (or activated) by Atelectasis, the major anatomic alteration of the lungs associated with diaphragmatic hernia.

• #11

• #12 The etiology of congenital diaphragmatic hernia: the retinoid hypothesis 20 years later | Pediatric Research

  https://www.nature.com/articles/s41390-023-02905-7

  Population-based studies have provided insight into the link between CDH and the Retinoid Hypothesis, primarily in the context of adequate maternal dietary vitamin A intake. […] There is collective epidemiological evidence that low maternal dietary vitamin A intake is a risk factor for CDH, although this concept requires further exploration.

• #13 Mild Congenital Diaphragmatic Hernia Can ‘Hide’ Until After Birth | Children’s Hospital of Philadelphia

  https://www.chop.edu/news/mild-congenital-diaphragmatic-hernia-can-hide-until-after-birth

  Congenital diaphragmatic hernia (CDH) occurs in up to 1 in 2 500 live births when the abdominal viscera herniate into the chest through a diaphragmatic defect. […] While prenatal referral to specialized high-volume centers, advanced ventilation strategies and pulmonary hypertension management, and extracorporeal membrane oxygenation (ECMO) have improved outcomes, mortality from CDH remains high between 25% to 30%. […] Over 60% of CDH cases are diagnosed on a routine 18-to-22-week anatomy ultrasound. […] In more mild cases, a CDH may not be identified until postnatal life, either in the delivery room, or sometimes weeks, months, or even years later when the patient presents with mild gastrointestinal or respiratory symptoms or has a chest X-ray. […] Although a rare diagnosis, infants with ongoing respiratory distress and tachypnea should have an X-ray with careful attention to the possibility of a CDH.

• #14 Congenital Diaphragmatic Hernias – Part 1 : Virtual Library

  https://resources.wfsahq.org/atotw/congenital-diaphragmatic-hernias-part-1/

  Congenital diaphragmatic hernia (CDH) is a developmental defect in the diaphragm that involves the protrusion of abdominal organs into the thorax. It is a rare defect with a worldwide prevalence of between 1:3500 and 5000 of live births. […] Between 50% and 60% of cases are diagnosed antenatally on routine ultrasound imaging. […] The mode of delivery should be guided by maternal status. […] It is important to remember that CDH is not a surgical emergency. […] Pulmonary hypertension (PPHN) is common in CDH, and an echocardiogram within 24 hours after birth is essential. […] The aim of prenatal intervention is to reduce the extent of lung hypoplasia and promote normal lung development. […] CDHs are rare developmental defects. The pathophysiological processes are complex and dynamic.

• #15 Congenital diaphragmatic hernia (CDH) in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/congenital-diaphragmatic-hernia-cdh-in-neonates

  Eighty per cent of babies with congenital diaphragmatic hernia (CDH) are diagnosed prenatally and are therefore born in a tertiary hospital. […] Around 15-25 cases occur each year in Victoria corresponding to an incidence of approximately 1:3000. […] With the virtual universal occurrence of mid trimester ultrasound examination for fetal abnormality more than 80 per cent of cases are now prenatally detected. […] The high mortality rate illustrates the importance of thorough evaluation, from the time of suspected fetal diagnosis, by a multidisciplinary team familiar with all aspects of the diagnosis and management of CDH. […] Reported survival for live born infants ranges from 50 to 90 per cent. The international CDH study group database with more than 1,600 patients reports an overall survival of 66 per cent. […] The experience for babies managed at the Royal Children’s Hospital, Melbourne shows the survival for babies with isolated lesions to be approximately 80 per cent based on more than 240 infants.

• #16 2024 AAP National Conference & Exhibition

  https://aapexperience24.eventscribe.net/ajaxcalls/PosterInfo.asp?PosterID=681598

  The incidence of congenital diaphragmatic hernia (CDH) is about 2.6 in 10,000 livebirths based on birth defect registries in the United States (US). […] We conducted a population-based study to determine the trends in incidence and mortality in infants with CDH through 1 year of age. […] There was no significant change in the CDH incidence during the study period (AAPC 0.93%; CI: -0.1, 2.0). […] The overall CDH-IMR (per 100,000) was 5.9 and it declined significantly from 5.6 in 2002 to 5.1 in 2019 (AAPC: -0.7%; CI: -1.3, -0.1). […] The downward trend in mortality needs ongoing surveillance to monitor the impact of new management strategies on mortality rates.

• #17 Congenital Diaphragmatic hernia – a review | Maternal Health, Neonatology and Perinatology | Full Text

  https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-017-0045-1

  Congenital Diaphragmatic hernia (CDH) is characterized by a defect in the diaphragm leading to the protrusion of abdominal contents into the thoracic cavity affecting the normal development of the lungs. The incidence of CDH based on the available literature ranges from approximately 0.8 – 5/10,000 births and varies across the population. There is slightly higher male predominance and a lower risk of isolated CDH reported among African-Americans. In spite of advances made in the medical and surgical management of CDH, the mortality and morbidity remain high. CDH infants also have a prolonged length of stay in the hospital requiring multi-disciplinary approach for their management and follow-up after hospital discharge. […] Major determinants of the outcomes in CDH are i) the presence of associated anomalies especially heart disease and ii) extent of lung hypoplasia and (iii) position of the liver. The prognosis of isolated CDH is generally better than CDH complicated by multiple anomalies. Population-based studies report higher survival for isolated CDH compared to CDH with anomalies.

• #17 Congenital Diaphragmatic hernia – a review | Maternal Health, Neonatology and Perinatology | Full Text

  https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-017-0045-1

  Liver herniation (liver-up) is associated with worse prognosis. Earlier studies have reported 100% survival without liver herniation (liver-down) as compared to 56% with liver herniation. The survival decreased from 74 to 45% with liver herniation as reported by a meta-analysis. In another study, liver herniation was highly predictive of ECMO (80% – liver-up vs. 25% – liver-down) and survival (45% – liver-up vs. 93% liver-down). […] With advances in the management of CDH, the overall survival has improved and has been reported to be 70-90% in non-ECMO infants and up to 50% in infants who undergo ECMO.

• #18 Congenital Diaphragmatic Hernia (CDH) | Memorial Hermann

  https://memorialhermann.org/services/conditions/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia (CDH) is a complex condition that requires immediate care from a team of specialists upon diagnosis, which can be a vital component to successful outcomes for patients. CDH affects approximately 1,000 babies each year and many will have severe complications at birth and throughout childhood. […] Based on risk-adjusted data, Children’s Memorial Hermann Hospital’s CDH postnatal outcomes rank in the top 10% or higher worldwide. […] The affiliated physician researchers at Children’s Memorial Hermann Hospital are actively involved in research projects focused on the mechanisms, treatment, and cure of CDH and other fetal disorders with the goal of improving patient outcomes. […] As leaders in CDH research, our affiliated physicians are pushing the envelope aiming to improve long-term outcomes for kids with CDH. The multidisciplinary physician team has played a major role in the continued advancement of CDH care, having cumulatively published more medical journal articles on CDH than most centers in the world, providing education on CDH by teaching courses locally and giving lectures throughout the country, and furthering research by gathering data to track long-term outcomes. The affiliated team’s long history of dedication to advancing CDH research and outcomes has resulted in the program’s position as a national referral center.

• #19 Diaphragmatic Hernias: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/934824-overview

  CDH has been estimated to occur in 1 in 5000 live births in the United States and approximately 2.3 per 10,000 live births globally. Prevalence varies across geographic regions, and estimates may include both isolated and nonisolated cases. […] It is likely that prevalence is underestimated, given that stillbirth and pregnancy termination are often excluded. Another challenge to obtaining accurate figures is variation in antenatal detection, which has dramatically improved over time but remains dependent on geographical location. Such challenges are likely to result in underreporting or missing data in epidemiologic studies. […] ADH is relatively uncommon. Fewer than 1% of patients who sustain trauma have an associated diaphragmatic injury. Most cases occur in the third decade of life. The male-to-female ratio is 4:1.

• #20 Congenital Diaphragmatic Hernia | UKOSS | NPEU

  https://www.npeu.ox.ac.uk/ukoss/completed-surveillance/cdh

  Currently we have limited information about the extent to which CDH is diagnosed and managed antenatally across the UK. […] Population-based incidence information and information about the impact of different management strategies, is essential to provide a true picture of the prognosis for infants with CDH in the UK. […] At present we have limited UK-based information about the diagnosed incidence and birth incidence and prevalence of CDH, especially in areas of the country not covered by a regional congenital anomaly register. […] The optimum management of the fetus and newborn with CDH remains contentious. […] Population-based information to describe the overall picture from antenatal diagnosis, and the impact of different management strategies, is essential to provide a true picture of the prognosis in the UK for fetuses/infants with CDH in the early 21st century.

• #21 613 Congenital Diaphragmatic Hernia Surveillance in Ireland | Archives of Disease in Childhood

  https://adc.bmj.com/content/97/Suppl_2/A178.1

  The incidence of Congenital Diaphragmatic Hernia (CDH) varies from 1 in 2,000 to 15,000 births per annum. […] There is no mandatory reporting of CDH cases in the ROI and Northern Ireland (NI). […] The incidence rate in the 2 years using IPSU figures was 0.12 per 1000 live births per annum. […] It was difficult to determine the true incidence of CDH using the IPSU data due under-reporting. Increased reporting may be achieved by raising awareness and by the use of capture-recapture mechanism. The establishment of a national congenital anomaly register is also indicated.

• #22

  https://journals.lww.com/annalsofsurgery/abstract/9900/epidemiology_and_regional_variation_in_additional.1076.aspx

  To determine practice variation in surgical management of co-morbidities in pediatric patients with Congenital Diaphragmatic Hernia (CDH). […] A higher percentage of CDH patients are surviving to discharge, accompanied by an increase in morbidity requiring surgical interventions such as tracheostomy and gastrostomy tube insertion. The frequency, trends, and regional variations in operative management of these co-morbidities in this population are unclear. […] 4003 patients underwent CDH repair and were discharged from their index hospitalization. 1939 (48%) underwent at least one additional surgical procedure after the index CDH repair. […] Covariates associated with additional surgical morbidity included: prematurity (OR 1.38; 95% CI: 1.20-1.59), cardiac co-morbidity (OR 1.31; 95% CI: 1.14-1.49), and chromosomal anomalies (OR 1.76, 95% CI: 1.30-2.40). Northeast (OR: 2.43; CI 1.42-3.52), Midwest (OR 2.11; 95% CI: 1.45-3.07), and South (OR 1.45, 95% CI 1.02-2.12) regions were associated with additional surgical morbidity. […] Surgical morbidity exists in CDH patients after initial CDH repair. Counseling families on these outcomes is important in establishing expectations for management. Establishing guidelines for optimal surgical management will require continued reporting from multi-institutional studies.

• #23 CDH International – A Global Initiative to Stop Congenital Diaphragmatic Hernia – Research: Epidemiology and Regional Variation in Additional Surgical Interventions for Children with Congenital Diaphragmatic Hernia: A Multi-institutional Analysis

  https://cdhi.org/research-epidemiology-and-regional-variation-in-additional-surgical-interventions-for-children-with-congenital-diaphragmatic-hernia-a-multi-institutional-analysis/

  Objective: To determine practice variation in surgical management of co-morbidities in pediatric patients with Congenital Diaphragmatic Hernia (CDH). […] A higher percentage of CDH patients are surviving to discharge, accompanied by an increase in morbidity requiring surgical interventions such as tracheostomy and gastrostomy tube insertion. The frequency, trends, and regional variations in operative management of these co-morbidities in this population are unclear. […] 4003 patients underwent CDH repair and were discharged from their index hospitalization. 1939 (48%) underwent at least one additional surgical procedure after the index CDH repair. […] Covariates associated with additional surgical morbidity included: prematurity (OR 1.38; 95% CI: 1.20-1.59), cardiac co-morbidity (OR 1.31; 95% CI: 1.14-1.49), and chromosomal anomalies (OR 1.76, 95% CI: 1.30-2.40). Northeast (OR: 2.43; CI 1.42-3.52), Midwest (OR 2.11; 95% CI: 1.45-3.07), and South (OR 1.45, 95% CI 1.02-2.12) regions were associated with additional surgical morbidity. […] Surgical morbidity exists in CDH patients after initial CDH repair. Counseling families on these outcomes is important in establishing expectations for management. Establishing guidelines for optimal surgical management will require continued reporting from multi-institutional studies.

• #24 Postoperative Congenital Diaphragmatic Hernia: What the Radiologist Needs to Know | Applied Radiology

  https://www.appliedradiology.com/Articles/postoperative-congenital-diaphragmatic-hernia-what-the-radiologist-needs-to-know

  Congenital diaphragmatic hernia (CDH) in which a defect in the diaphragm permits intra-abdominal and/or retroperitoneal structures to move into the thorax, is a complex condition with a prevalence of 1 in 2,500 to 1 in 5,000 live births. […] As increasing experience in prenatal and neonatal care has improved the overall survival rate of CDH, postoperative management is vital to improving patient outcomes and quality of life. […] With improving survival, patients with corrected CDH are more prevalent. […] Many centers advocate close follow-up initially, with gradual spacing of follow-up, often including pre-visit chest radiography, throughout childhood. […] Patients may present with mild chest pain or, more seriously, respiratory failure or bowel obstruction. […] Complications of CDH repair may occur intraoperatively or postoperatively during or after the hospital stay.

• #24 Postoperative Congenital Diaphragmatic Hernia: What the Radiologist Needs to Know | Applied Radiology

  https://www.appliedradiology.com/Articles/postoperative-congenital-diaphragmatic-hernia-what-the-radiologist-needs-to-know

  Functional sequelae associated with the GI system are expected in most postoperative cases. […] Pulmonary sequelae of CDH are seen in the majority of CDH survivors. […] Imaging can also reveal neurological abnormalities associated with CDH. […] Patient management of CDH survivors is a lifelong process.

• #25 Congenital Diaphragmatic Hernia: Symptoms and Treatment

  https://patient.info/doctor/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia occurs in about 1 in 3300 live births. […] Right-sided lesions are rare (10-15%) compared with left-sided (85%) as the liver plugs the opening. Right congenital diaphragmatic hernia carries a disproportionately high mortality and morbidity. […] Infants with CDH should undergo long-term, multidisciplinary surveillance that includes standardised neurodevelopmental testing, especially if they are considered high risk (needing pulmonary support at 30 days, needing a patch repair or requiring extracorporeal life support).

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