Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates.

GOMES FERREIRA, Cindy, KUHN, Pierre, LACREUSE, Isabelle, KASLEAS, Christos, PHILIPPE, Paul, PODEVIN, Guillaume, BONNARD, Arnaud, LOPEZ, Manuel, DE LAGAUSIE, Pascal, PETIT, Thierry, LARDY, Hubert et BECMEUR, Francois, 2013. Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. Journal of pediatric surgery [en ligne]. mars 2013. Vol. 48, n° 3pp. 488-95. [Consultésans date]. DOI 10.1016/j.jpedsurg.2012.09.060. Consulté de : http://www.sciencedirect.com/science/article/pii/S0022346812007865?via%3Dihub1. journal article. 2. 2013 Mar. 3. . 4. imported. 5. .
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Auteurs Cindy Gomes Ferreira
Pierre Kuhn
Isabelle Lacreuse
Christos Kasleas
Paul Philippe
Guillaume Podevin
Arnaud Bonnard
Manuel Lopez
Pascal De Lagausie
Thierry Petit
Hubert Lardy
Francois Becmeur
Unité de recherche du site Biomatériaux et bioingénierie - BB - UMRS1121
URL éditeur http://www.sciencedirect.com/science/article/pii/S0022346812007865?via%3Dihub
Langue

en
Volume

48
Numéro

3
Page de début

488
Page de fin

495
Date de première publication

2013-03
Date de parution

2013-03
Titre de la source (revue, livre…)

Journal of pediatric surgery
Résumé

PURPOSE: Publications aiming to prove the feasibility and safety of thoracoscopic CDH-repair in neonates grow in numbers. Some teams use selection criteria, but none have proven statistical evidence. The aim of this study is to detect risk factors
Show morePURPOSE: Publications aiming to prove the feasibility and safety of thoracoscopic CDH-repair in neonates grow in numbers. Some teams use selection criteria, but none have proven statistical evidence. The aim of this study is to detect risk factors for failure of thoracoscopic primary closure of CDH in neonates. METHODS: In 8 centers performing minimal access surgery (MAS), complete prenatal, postnatal, and operative data were evaluated for a retrospective study concerning patients with thoracoscopic congenital diaphragmatic hernia (CDH) repair. Most of the selection criteria and risk factors mentioned in the literature were analyzed. Two groups were defined: Group A - neonates who tolerated thoracoscopic primary repair, and Group B - neonates who required conversion or presented with major complications after thoracoscopic repair. Univariate and multivariate logistic regressions were used to compare these two groups. RESULTS: From 2006 to 2010, thoracoscopy was performed in 40 neonates: Group A consisting of 28 neonates, and Group B 9 patients. Three patients were excluded because of insufficient data or major associated malformations. Significant statistical differences were found in Group B for postnatal PaCO2 >60 mmHg, need of iNO during postnatal stabilization, intrathoracic position of the stomach, pulmonary hypertension signs on the postnatal cardiac ultrasound, and preoperative OI >3.0. On multivariate analysis, only an OI >3.0 was significantly associated with conversion or major post-operative complication of thoracoscopic primary repair. CONCLUSION: CDH can be safely repaired in the neonatal period by thoracoscopy. The limiting factor for thoracoscopic CDH repair is PPHN. The best preoperative indicator for PPHN is OI. Prospective studies are nonetheless necessary to prove the effectiveness of using these risk factors as selection criteria to help design surgical management protocols for neonates presenting CDH.
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DOI 10.1016/j.jpedsurg.2012.09.060
Éditeur

Elsevier
Titre abrégé de la source

J Pediatr Surg
Type de publication

journal article
Type de publication

ACL
Domaine

Aucun
PMID 23480901
Fonction

aut
Audience

Non spécifiée