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Is it possibble to predict survival in cases with congenital diaphragmatic hernia?

Yıl 2015, Cilt: 46 Sayı: 3, 123 - 128, 16.03.2015
https://doi.org/10.16948/zktb.58066

Öz

Objective: This study was planned to determine whether there is a correlation between diagnosis criteria and survival and morbidity rates and to show the importance of blood gas values taken in the first 24 hours with a view to prognostic survival predictions in newborns with CDH treated and followed at our department.

Material and Method: This study was carried out prospectively covering newborns with CDH treated and followed between January 2006 and May 2009. For the gathering of data; demographic features, diagnostic time (prenatal/postnatal), all findings of laboratory and radiology, treatment characteristics, early stage post-operative complications, and results were evaluated.

Results: 37 newborn with congenital diaphragmatic hernia were hospitalized, followed and treated at our department during 29 months period. 18 were female (48.6%) and 19 were male (51.4%). Prenatal diagnosis was made in 30.3%. Ultrasonography showed polyhydramnios in 5 out of 15 cases (41.6%) diagnosed prenatally and polyhydramnios with intrathoracic stomach in 3 cases (25.1%). Spontaneous delivery was happened in 54.5%. Hernia was on the left side in 72.7% of the patients, and 21.7% of patients had involved major anomalies. The difference between dying and surviving cases was found statistically significant according to 1st and 5th minute APGAR scores, and MAP, VI, MVI, OI, PIP values, and existence of major anomalies.

Conclusion: This study demonstrated that the prenatal diagnosis before 25th week, existence of major anomalies, 1st and 5th minute APGAR scores, PIP, OI and MVI values may be used in order to make a prediction as a prognostic factor in cases with CDH. Although statistically significant relationship between the mortality rate and polyhydramnios and/or prenatal diagnosis and survive were not significantly; lower than 40 of the MVI was found to be helpful in positive predicting on survival of cases with CDH.

Kaynakça

  • Gosche JR, Islam S, Boulanger SC. Congenital diaphragmatic hernia: Searching for answers. Am J Surg 2005; 190: 324-332.
  • Hout L, Sluiter I, Gischler S, Klein A, Rottier R, Ijsselstijn H, Reiss I, Tibboel D. Can we improve outcome of congenital diaphragmatic hernia?. Pediatr Surg Int 2009; 25: 733-743.
  • Stege G, Fenton A, Jaffray B. Nihilism in the 1990’s: The true mortality of congenital diaphragmatic hernia. Pediatrics 2003; 112: 532-535.
  • Iritani I. Experimental study on embriyogenesis of congenital diaphragmatic hernia. Anat Embryol 1984; 169: 133-139.
  • Ssemakula N, Stewart DL, Goldsmith LJ, Cook LN, Bond SJ. Survival of Patients With Congenital Diaphragmatic Hernia During the ECMO Era: An l1Year Experience. J Pediatr Surg 1997; 32: 1683-1689.
  • Garne E, Haeusler M, Barisic I, et al. Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions. Ultrasound Obstet Gynecol 2002; 19: 329-333.
  • The Congenital Diaphragmatic Hernia Study Group. Defect Size Determines Survival in Infants With Congenital Diaphragmatic Hernia. Pediatr 2007; 120: 651-657.
  • Rocha GM, Bianchi RF, Severo M, Rodrigues MM, Baptista MJ, Pinto JC, Guimarães HA. Congenital Diaphragmatic Hernia – The Neonatal Period (Part I). Eur J Pediatr Surg 2008; 18: 219-223.
  • Garne E, Haeusler M, Barısıc I, Gjergja R, Stoll C, Clementı M. and The Euroscan Study Group. Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions. Ultrasound Obstet Gynecol 2002; 19: 329-333.
  • Gallot D, Boda C, Ughetto S, Perthus I, Robert-Gnansi E, Francannet C, Laurichesse-Delmas H, Jani J, Coste K, Labbe A, Sapin V, Lemery D. Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol 2007; 29: 276-283.
  • Yang W, Carmichael SL, Harris JA, Shaw GM. Epidemiologic Characteristics of Congenital Diaphragmatic Hernia among 2.5 Million California Births, 1989–1997 Birth Defects Research (Part A) 2006; 76:170-174.
  • Levison J, Halliday R, Holland AJA, Walker K, Williams G, Shi E, Badawi N. A population-based study of congenital diaphragmatic hernia outcome in New South Wales and the Australian Capital Territory, Australia, 1992-2001. J Pediatr Surg 2006; 41, 1049-1053.
  • Schultz CM, DiGeronimo RJ, Yoder BA. Congenital diaphragmatic hernia: A simplified postnatal predictor of outcome. Journal of Pediatric Surgery 2007; 42, 510-551.
  • The Congenital Diaphragmatic Hernia Study Group. Estimating disease severity of congenital diaphragmatic hernia in the first 5 minutes of life. J Pediatr Surg 2001; 36: 141-145.
  • Wilson JM, Bower LK, Lund DP: Evolution of the technique of congenital diaphragmatic hernia repair on ECMO. J Pediatr Surg 1994 Aug; 29(8): 110912.
  • Azarow K, Messineo A, Pearl R, Filler R, Barker G, Bohn D. Congenital diaphragmatic hernia-A tale of two cities: The Toronto experience. J Pediatr Surg1997; 32: 395-400.
  • Celayir S, İlçe Z, Kılıç N, Sarımurat N, Erdoğan E, Yeker D. Konjenital Diyafragma Hernisi (1978-1998). Cerrahpaşa J Med 1999; 30(4): 259-264.
  • Rocha GM, Bianchi RF, Azevedo I, Pinto JC, Guimarães HA. Congenital Diaphragmatic Hernia. The Post-Neonatal Period (Part II). Eur J Pediatr Surg 2008; 18: 307-312.
  • Desfrere L, Jarreau PH, Dommergues M, Brunhes A, Hubert P, Nihoul-Fekete, Mussat P, Moriette G. Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns. Intensive Care Med 2000; 26: 934-941.
  • Wung JT, James LS, Kilchevsky E, et al. Management of infants with severe respiratory failure and persistence of the fetal circulation without hyperventilation. Pediatr 1985; 76: 488-494.
  • Taeng GY, Derry C, Marston L, Choudhury M, Holmes K, Calvert SA. Reduction in ventilator-induced lung injury improves outcome in congenital diaphragmatic hernia? Pediatr Surg Int 2008; 24: 145-150.

Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?

Yıl 2015, Cilt: 46 Sayı: 3, 123 - 128, 16.03.2015
https://doi.org/10.16948/zktb.58066

Öz

Amaç: Bu çalışma, konjenital diyafragma hernili (KDH) olgularda prenatal tanılama kriterlerinin veya postnatal erken klinik ve laboratuvar bulgularının prognoza etkisinin gösterilmesi ve buna göre yaşamsal öngörüde bulunabilmek amacıyla planlanmıştır.

Gereç ve Yöntem: Çalışma Ocak 2006 ve Mayıs 2009 tarihleri arasında kliniğimizde takip ve tedavi edilen KDH olgularında ileriye dönük olarak yapıldı. Olguların tanı zamanı, doğum yeri ve şekli, demografik özellikler, fizik muayene ve laboratuvar bulgular, tedavi ve sonuçlar değerlendirildi.

Bulgular: 29 aylık sürede 33 konjenital diyafragma hernili yenidoğanın 17’si erkek (%51,5), 16’sı kız (%48,5) olup; anne yaş ortalaması 25,18±5,34 yaş, gestasyon yaş ortalaması 36,8±3,36 hafta, doğum kilosu ortalaması 2742,12±701 gr. idi. %30,3’ünün (n:10) prenatal tanısının olduğu, %54,5’inin (n:18) normal spontan vajinal yolla doğduğu; %72,7’sinde (n:24)  diyafragmatik herninin solda olduğu; %21,2 olguda (n:7) majör anomalilerin eşlik ettiği belirlendi. Ameliyat sonrası 10 olgu (%33) yaşadı. Sağ kalım oranı MVI 40 ve altında olanlarda, 40 üzeri olanlara göre göre anlamlı düzeyde yüksek bulundu.

Sonuç: Çalışmada KDH olgularında 25. haftadan erken tanı, majör anomaliler, 1. ve 5. dakika APGAR skorları, PIP, OI ve MVI değerlerinin prognostik açıdan öngörüde kullanılabileceği gösterildi. KDH’li olgularda prenatal tanılama ile sağkalım arasında veya polihidramnios ile ölüm oranı arasında istatistiksel açıdan anlamlı ilişki saptanamazken, MVI indeksinin 40’ın altında olmasının sağ kalım üzerinde pozitif öngörüde bulunmaya yardımcı olduğu saptandı. 

Kaynakça

  • Gosche JR, Islam S, Boulanger SC. Congenital diaphragmatic hernia: Searching for answers. Am J Surg 2005; 190: 324-332.
  • Hout L, Sluiter I, Gischler S, Klein A, Rottier R, Ijsselstijn H, Reiss I, Tibboel D. Can we improve outcome of congenital diaphragmatic hernia?. Pediatr Surg Int 2009; 25: 733-743.
  • Stege G, Fenton A, Jaffray B. Nihilism in the 1990’s: The true mortality of congenital diaphragmatic hernia. Pediatrics 2003; 112: 532-535.
  • Iritani I. Experimental study on embriyogenesis of congenital diaphragmatic hernia. Anat Embryol 1984; 169: 133-139.
  • Ssemakula N, Stewart DL, Goldsmith LJ, Cook LN, Bond SJ. Survival of Patients With Congenital Diaphragmatic Hernia During the ECMO Era: An l1Year Experience. J Pediatr Surg 1997; 32: 1683-1689.
  • Garne E, Haeusler M, Barisic I, et al. Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions. Ultrasound Obstet Gynecol 2002; 19: 329-333.
  • The Congenital Diaphragmatic Hernia Study Group. Defect Size Determines Survival in Infants With Congenital Diaphragmatic Hernia. Pediatr 2007; 120: 651-657.
  • Rocha GM, Bianchi RF, Severo M, Rodrigues MM, Baptista MJ, Pinto JC, Guimarães HA. Congenital Diaphragmatic Hernia – The Neonatal Period (Part I). Eur J Pediatr Surg 2008; 18: 219-223.
  • Garne E, Haeusler M, Barısıc I, Gjergja R, Stoll C, Clementı M. and The Euroscan Study Group. Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions. Ultrasound Obstet Gynecol 2002; 19: 329-333.
  • Gallot D, Boda C, Ughetto S, Perthus I, Robert-Gnansi E, Francannet C, Laurichesse-Delmas H, Jani J, Coste K, Labbe A, Sapin V, Lemery D. Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol 2007; 29: 276-283.
  • Yang W, Carmichael SL, Harris JA, Shaw GM. Epidemiologic Characteristics of Congenital Diaphragmatic Hernia among 2.5 Million California Births, 1989–1997 Birth Defects Research (Part A) 2006; 76:170-174.
  • Levison J, Halliday R, Holland AJA, Walker K, Williams G, Shi E, Badawi N. A population-based study of congenital diaphragmatic hernia outcome in New South Wales and the Australian Capital Territory, Australia, 1992-2001. J Pediatr Surg 2006; 41, 1049-1053.
  • Schultz CM, DiGeronimo RJ, Yoder BA. Congenital diaphragmatic hernia: A simplified postnatal predictor of outcome. Journal of Pediatric Surgery 2007; 42, 510-551.
  • The Congenital Diaphragmatic Hernia Study Group. Estimating disease severity of congenital diaphragmatic hernia in the first 5 minutes of life. J Pediatr Surg 2001; 36: 141-145.
  • Wilson JM, Bower LK, Lund DP: Evolution of the technique of congenital diaphragmatic hernia repair on ECMO. J Pediatr Surg 1994 Aug; 29(8): 110912.
  • Azarow K, Messineo A, Pearl R, Filler R, Barker G, Bohn D. Congenital diaphragmatic hernia-A tale of two cities: The Toronto experience. J Pediatr Surg1997; 32: 395-400.
  • Celayir S, İlçe Z, Kılıç N, Sarımurat N, Erdoğan E, Yeker D. Konjenital Diyafragma Hernisi (1978-1998). Cerrahpaşa J Med 1999; 30(4): 259-264.
  • Rocha GM, Bianchi RF, Azevedo I, Pinto JC, Guimarães HA. Congenital Diaphragmatic Hernia. The Post-Neonatal Period (Part II). Eur J Pediatr Surg 2008; 18: 307-312.
  • Desfrere L, Jarreau PH, Dommergues M, Brunhes A, Hubert P, Nihoul-Fekete, Mussat P, Moriette G. Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns. Intensive Care Med 2000; 26: 934-941.
  • Wung JT, James LS, Kilchevsky E, et al. Management of infants with severe respiratory failure and persistence of the fetal circulation without hyperventilation. Pediatr 1985; 76: 488-494.
  • Taeng GY, Derry C, Marston L, Choudhury M, Holmes K, Calvert SA. Reduction in ventilator-induced lung injury improves outcome in congenital diaphragmatic hernia? Pediatr Surg Int 2008; 24: 145-150.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ÇOCUK CERRAHİSİ
Yazarlar

Alp Gence Bu kişi benim

Ayşenur Cerrah Celayir

Yayımlanma Tarihi 16 Mart 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 46 Sayı: 3

Kaynak Göster

APA Gence, A., & Cerrah Celayir, A. (2015). Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?. Zeynep Kamil Tıp Bülteni, 46(3), 123-128. https://doi.org/10.16948/zktb.58066
AMA Gence A, Cerrah Celayir A. Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?. Zeynep Kamil Tıp Bülteni. Ekim 2015;46(3):123-128. doi:10.16948/zktb.58066
Chicago Gence, Alp, ve Ayşenur Cerrah Celayir. “Konjenital Diyafragma Hernisinde sağkalım üzerine öngörü yapılabilir Mi?”. Zeynep Kamil Tıp Bülteni 46, sy. 3 (Ekim 2015): 123-28. https://doi.org/10.16948/zktb.58066.
EndNote Gence A, Cerrah Celayir A (01 Ekim 2015) Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?. Zeynep Kamil Tıp Bülteni 46 3 123–128.
IEEE A. Gence ve A. Cerrah Celayir, “Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?”, Zeynep Kamil Tıp Bülteni, c. 46, sy. 3, ss. 123–128, 2015, doi: 10.16948/zktb.58066.
ISNAD Gence, Alp - Cerrah Celayir, Ayşenur. “Konjenital Diyafragma Hernisinde sağkalım üzerine öngörü yapılabilir Mi?”. Zeynep Kamil Tıp Bülteni 46/3 (Ekim 2015), 123-128. https://doi.org/10.16948/zktb.58066.
JAMA Gence A, Cerrah Celayir A. Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?. Zeynep Kamil Tıp Bülteni. 2015;46:123–128.
MLA Gence, Alp ve Ayşenur Cerrah Celayir. “Konjenital Diyafragma Hernisinde sağkalım üzerine öngörü yapılabilir Mi?”. Zeynep Kamil Tıp Bülteni, c. 46, sy. 3, 2015, ss. 123-8, doi:10.16948/zktb.58066.
Vancouver Gence A, Cerrah Celayir A. Konjenital diyafragma hernisinde sağkalım üzerine öngörü yapılabilir mi?. Zeynep Kamil Tıp Bülteni. 2015;46(3):123-8.