Congenital diaphragmatic hernia medical therapy: Difference between revisions
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{{Congenital diaphragmatic hernia}} | {{Congenital diaphragmatic hernia}} | ||
{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:AroojNaz|Arooj Naz, M.B.B.S]] | |||
==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
* [[Extracorporeal membrane oxygenation|ECMO]] has been used as part of the treatment strategy at some hospitals | |||
=== Antenatal Management <ref name="pmid32310536">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=32310536 | doi= | pmc= | url= }}</ref> === | |||
* Close monitoring to assess for fetal well-being; [[fetal therapy]] may be offered to eligible patients which involves occlusion of the fetal trachea at 26-30 weeks of gestation which allows fluid accumulation in the lung and its stretching. This results in release of [[surfactant]] but a potentially increased risk of [[preterm delivery]]. Post-natal CDH repair is still required <ref name="pmid23378478">{{cite journal| author=Haroon J, Chamberlain RS| title=An evidence-based review of the current treatment of congenital diaphragmatic hernia. | journal=Clin Pediatr (Phila) | year= 2013 | volume= 52 | issue= 2 | pages= 115-24 | pmid=23378478 | doi=10.1177/0009922812472249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23378478 }}</ref> | |||
=== Postnatal Management <ref name="pmid323105362">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=32310536 | doi= | pmc= | url= }}</ref> === | |||
* Ensure delivery is not before 37 weeks , preferably at 39-40 weeks | |||
* [[Extracorporeal membrane oxygenation|Extracorporeal membrane oxygenation (ECMO)]] therapy has been used as part of the treatment strategy at some hospitals <ref name="pmid17706494">{{cite journal |author=Tiruvoipati R, Vinogradova Y, Faulkner G, Sosnowski AW, Firmin RK, Peek GJ |title=Predictors of outcome in patients with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation |journal=J. Pediatr. Surg. |volume=42 |issue=8 |pages=1345–50 |year=2007 |pmid=17706494 |doi=10.1016/j.jpedsurg.2007.03.031}}</ref><ref name="pmid17637787">{{cite journal |author=Logan JW, Rice HE, Goldberg RN, Cotten CM |title=Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies |journal=Journal of perinatology : official journal of the California Perinatal Association |volume=27 |issue=9 |pages=535–49 |year=2007 |pmid=17637787 |doi=10.1038/sj.jp.7211794}}</ref> | |||
==== Delivery Room Management ==== | |||
* Immediate use of [[nasogastric tube]] to decompress the [[stomach]] and [[intestines]] | |||
* Immediate [[intubation]] in case of [[respiratory distress]] | |||
{| class="wikitable" | |||
|+Target Values for Pulmonary Ventilation | |||
!Parameter | |||
!Value | |||
|- | |||
|Pre-ductal saturation | |||
|85%-95% | |||
|- | |||
|PIP | |||
|< 25 cm H2O | |||
|- | |||
|PEEP | |||
|3-5 cm H2O | |||
|- | |||
|PCO2 | |||
|45-60 mmHg | |||
|} | |||
==== Management of Pulmonary Hypertension ==== | |||
* Adequate ventilation and oxygenation | |||
* [[Vasopressors]] | |||
* Inhaled [[nitric oxide]] ([[vasodilator]]) <ref name="pmid26463502">{{cite journal| author=Puligandla PS, Grabowski J, Austin M, Hedrick H, Renaud E, Arnold M | display-authors=etal| title=Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee. | journal=J Pediatr Surg | year= 2015 | volume= 50 | issue= 11 | pages= 1958-70 | pmid=26463502 | doi=10.1016/j.jpedsurg.2015.09.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26463502 }}</ref> | |||
* Other drugs: [[sildenafil]], [[bosentan]], [[Alprostadil|PGE1]], [[Prostacyclin|PGI2]] | |||
==References== | ==References== | ||
Revision as of 09:15, 23 April 2022
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Congenital diaphragmatic hernia Microchapters |
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Differentiating Congenital diaphragmatic hernia from Other Diseases |
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Congenital diaphragmatic hernia medical therapy On the Web |
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Risk calculators and risk factors for Congenital diaphragmatic hernia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S
Overview
Medical Therapy
Antenatal Management [1]
- Close monitoring to assess for fetal well-being; fetal therapy may be offered to eligible patients which involves occlusion of the fetal trachea at 26-30 weeks of gestation which allows fluid accumulation in the lung and its stretching. This results in release of surfactant but a potentially increased risk of preterm delivery. Post-natal CDH repair is still required [2]
Postnatal Management [3]
- Ensure delivery is not before 37 weeks , preferably at 39-40 weeks
- Extracorporeal membrane oxygenation (ECMO) therapy has been used as part of the treatment strategy at some hospitals [4][5]
Delivery Room Management
- Immediate use of nasogastric tube to decompress the stomach and intestines
- Immediate intubation in case of respiratory distress
| Parameter | Value |
|---|---|
| Pre-ductal saturation | 85%-95% |
| PIP | < 25 cm H2O |
| PEEP | 3-5 cm H2O |
| PCO2 | 45-60 mmHg |
Management of Pulmonary Hypertension
- Adequate ventilation and oxygenation
- Vasopressors
- Inhaled nitric oxide (vasodilator) [6]
- Other drugs: sildenafil, bosentan, PGE1, PGI2
References
- ↑ "StatPearls". ( ). 2022: . PMID 32310536 Check
|pmid=value (help). - ↑ Haroon J, Chamberlain RS (2013). "An evidence-based review of the current treatment of congenital diaphragmatic hernia". Clin Pediatr (Phila). 52 (2): 115–24. doi:10.1177/0009922812472249. PMID 23378478.
- ↑ "StatPearls". ( ). 2022: . PMID 32310536 Check
|pmid=value (help). - ↑ Tiruvoipati R, Vinogradova Y, Faulkner G, Sosnowski AW, Firmin RK, Peek GJ (2007). "Predictors of outcome in patients with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation". J. Pediatr. Surg. 42 (8): 1345–50. doi:10.1016/j.jpedsurg.2007.03.031. PMID 17706494.
- ↑ Logan JW, Rice HE, Goldberg RN, Cotten CM (2007). "Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies". Journal of perinatology : official journal of the California Perinatal Association. 27 (9): 535–49. doi:10.1038/sj.jp.7211794. PMID 17637787.
- ↑ Puligandla PS, Grabowski J, Austin M, Hedrick H, Renaud E, Arnold M; et al. (2015). "Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee". J Pediatr Surg. 50 (11): 1958–70. doi:10.1016/j.jpedsurg.2015.09.010. PMID 26463502.