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Congenital Diaphragmatic Hernia Repair at the Bedside or Operating Theater.
Niec, Jan A; Achey, Meredith A; Wallace, Marshall W; Patel, Anuradha; Zhao, Shilin; Hatch, L Dupree; Morris, Emily A; Danko, Melissa E; Pietsch, John B; Lovvorn, Harold N.
Afiliação
  • Niec JA; 12327Vanderbilt University School of Medicine, Nashville, TN, USA.
  • Achey MA; Department of Surgery, 5718Vanderbilt University Medical Center, Nashville, TN, USA.
  • Wallace MW; 12327Vanderbilt University School of Medicine, Nashville, TN, USA.
  • Patel A; Department of Pediatric Surgery, 12328Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • Zhao S; Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA.
  • Hatch LD; Division of Neonatology, Department of Pediatrics, 12328Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • Morris EA; Division of Neonatology, Department of Pediatrics, 12328Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • Danko ME; Department of Pediatric Surgery, 12328Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • Pietsch JB; Department of Pediatric Surgery, 12328Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • Lovvorn HN; Department of Pediatric Surgery, 12328Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Am Surg ; 88(8): 1814-1821, 2022 Aug.
Article em En | MEDLINE | ID: mdl-35337188
BACKGROUND: For critically ill congenital diaphragmatic hernia (CDH) patients on high frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and/or inhaled nitric oxide (iNO), operative repair in the neonatal intensive care unit (NICU) has been proposed to avoid complications during transport to an operating room (OR). This study compared neonates with CDH who received herniorrhaphy in the NICU or OR, with a subgroup analysis considering only patients supported with ECMO. METHODS: Patients admitted to the NICU in the first 2 weeks of life at a free-standing children's hospital between July 2004 and September 2021 were examined. Patients were categorized according to location of CDH repair, and impact on operative complications and survival was compared. RESULTS: 185 patients were admitted to the NICU with posterolateral CDH and received operative repair. 48 cases were operated on at the bedside in the NICU and 137 in the OR. Patients repaired in the NICU had higher use of HFOV, pulmonary vasodilators, and ECMO (all P < .001). Children repaired in the NICU experienced significantly higher in-hospital death and overall mortality (P < .001). However, in multivariate analysis, repair location was not a significant predictor of survival to discharge in patients receiving ECMO. No significant difference in surgical site infection was detected for operative location (P = .773). DISCUSSION: Congenital diaphragmatic hernia repair in the NICU occurred more frequently among higher risk patients who experienced worse survival. The rate of surgical site infection appeared similar overall and across subgroups suggesting adequate sterility and technique for bedside procedures, when necessary, despite restricted access to advanced operative equipment.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hérnias Diafragmáticas Congênitas Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans / Newborn Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hérnias Diafragmáticas Congênitas Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans / Newborn Idioma: En Ano de publicação: 2022 Tipo de documento: Article