Fetal Imaging & Therapy for CDH – Current Status
In congenital diaphragmatic hernia (CDH), herniation of the abdominal organs into the fetal chest causes pulmonary hypoplasia and pulmonary hypertension, the main causes of neonatal mortality. As antenatal ultrasound screening improves, the risk of postnatal death can now be better predicted, allowing for the identification of fetuses that might most benefit from a prenatal intervention. Fetoscopic tracheal occlusion is being evaluated in a large international randomized controlled trial. We will present the antenatal imaging approaches that can help identify fetuses that might benefit from antenatal therapy, and will revi...
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: Titilayo Oluyomi-Obi, Tim Van Mieghem, Greg Ryan Source Type: research
ECMO in CDH: Is there a role?
Despite its wide use, survival in congenital diaphragmatic hernia (CDH) patients treated with Extracorporeal Membrane Oxygenation (ECMO), as reported by the Extracorporeal Life Support Organization (ELSO), remains unchanged at 50%. High survival rates both with and without utilizing ECMO have been reported, fueling questions about the utility of ECMO support in this difficult population. This review looks at data from the Congenital Diaphragmatic Hernia study group and individual center reports, to evaluate the role of ECMO in CDH, focusing on defining the patients most likely to benefit, and discussing how those benefits ...
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: David W. Kays Source Type: research
Long Term Follow up of Congenital Diaphragmatic Hernia
Increased survival of patients with congenital diaphragmatic hernia has created a unique cohort of children, adolescent and adult survivors with complex medical and surgical needs. Disease-specific morbidities offer the opportunity for multiple disciplines to unite together to provide long-term comprehensive follow up, as well as an opportunity for research regarding late outcomes. These children can exhibit impaired pulmonary function, altered neurodevelopmental outcomes, nutritional insufficiency, musculoskeletal changes and specialized surgical needs that benefit from regular monitoring and intervention, particularly in...
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: Laura E. Hollinger, Matthew T. Harting, Kevin P. Lally Tags: 26/2 May - CDH issue Source Type: research
Congenital diaphragmatic hernia-associated pulmonary hypertension
Congenital diaphragmatic hernia (CDH) is a complex entity wherein a diaphragmatic defect allows intrathoracic herniation of intraabdominal contents and both pulmonary parenchymal and vascular development are stifled. Pulmonary pathology and pathophysiology, including pulmonary hypoplasia and pulmonary hypertension, are hallmarks of CDH and are associated with disease severity. Pulmonary hypertension (PH) is sustained, supra-normal pulmonary arterial pressure, and among patients with CDH (CDH-PH), is driven by hypoplastic pulmonary vasculature, including alterations at the molecular, cellular, and tissue levels, along with ...
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: Matthew T. Harting Source Type: research
Regenerative Medicine Solutions in Congenital Diaphragmatic Hernia
We report here the advancement in the field which will help both understanding further CDH development and offer new treatment options for the difficult situations such as repair of large diaphragmatic defects and lung hypoplasia. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: Paolo De Coppi, Jan Deprest Source Type: research
Predicting outcomes in congenital diaphragmatic hernia
Identification of CDH infant populations at high risk for mortality postnatally may help to develop targeted care strategies, guide discussions surrounding palliation and contribute to standardizing reporting and benchmarking so that care strategies at different centers can be compared. Clinical prediction rules are evidence-based tools that combine multiple predictors to estimate the probability that a particular outcome in an individual patient will occur. In CDH, a suitable clinical prediction rule can stratify high- and low-risk populations and provide the ability to tailor management strategies based on severity. (Sou...
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: Oluwatomilayo Daodu, Mary E. Brindle Source Type: research
Abnormal lung development in congenital diaphragmatic hernia
The outcomes of patients diagnosed with congenital diaphragmatic hernia (CDH) have recently improved. However, mortality and morbidity remain high, and this is primarily caused by the abnormal lung development resulting in pulmonary hypoplasia and persistent pulmonary hypertension. The pathogenesis of CDH is poorly understood, despite the identification of certain candidate genes disrupting normal diaphragm and lung morphogenesis in animal models of CDH. Defects within the lung mesenchyme and interstitium contribute to disturbed distal lung development. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - April 24, 2017 Category: Pediatrics Authors: Dustin Ameis, Naghmeh Khoshgoo, Richard Keijzer Source Type: research
Preface: Esophageal disorders
This edition of Seminars in Pediatric Surgery is dedicated to esophageal disorders. The esophagus holds a special place in the hearts of pediatric surgeons. We often define our specialty by the ability to successfully correct esophageal atresia. The esophagus can also be the bane of a pediatric surgeon ׳s existence. We manage recalcitrant strictures, poor motility, and suboptimal outcomes despite our best efforts. In this edition of Seminars in Pediatric Surgery, we have been fortunate enough to assemble articles by the leaders in the treatment of esophageal disorders. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - April 1, 2017 Category: Pediatrics Authors: Mark Wulcan Source Type: research
Contents
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Source: Seminars in Pediatric Surgery - April 1, 2017 Category: Pediatrics Source Type: research
Forthcoming topics
(Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - April 1, 2017 Category: Pediatrics Source Type: research
Hiatal and paraesophageal hernia repair in pediatric patients
Hiatal and paraesophageal hernia (HH/PEH) can be congenital, resulting from embryologic abnormalities/genetic predisposition, or acquired, most commonly after gastro-esophageal surgery such as fundoplication. Minimizing circumferential esophageal dissection at the time of Nissen fundoplication has been shown to decrease the risk of acquired HH/PEH from 36.5 to 12.2%. Gastrointestinal, respiratory and constitutional symptoms, including anemia and failure to thrive, are common with high rates of associated gastroesophageal reflux. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - March 7, 2017 Category: Pediatrics Authors: Erin M Garvey, Daniel J Ostlie Source Type: research
Esophageal duplication and congenital esophageal stenosis
(CES) may represent diseases with common embryologic etiologies - namely, they are examples of faulty tracheoesophageal separation and differentiation. Here we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 9, 2017 Category: Pediatrics Authors: A. Francois Trappey, Shinjiro Hirose Source Type: research
Caustic ingestion in children —A review
Various domestic or industrial chemicals may cause significant upper aerodigestive tract burns. Preventive measures should be up-scaled, especially in the developing world, to reduce the epidemic of accidental victims, largely unsupervised preschool children. External signs do not predict degree of injury. Non-invasive diagnostic screening includes radio-nuclear imaging, but early oesophago-gastroduodenoscopy remains the standard to predict stricture formation from circumferential submucosal scarring. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 3, 2017 Category: Pediatrics Authors: Marion Arnold, Alp Numanoglu Source Type: research
Caustic ingestion in children- a review
Various domestic or industrial chemicals may cause significant upper aerodigestive tract burns. Preventive measures should be up-scaled, especially in the developing world, to reduce the epidemic of accidental victims, largely unsupervised preschool children. External signs do not predict degree of injury. Non-invasive diagnostic screening includes radio-nuclear imaging, but early oesophago-gastroduodenoscopy remains the standard to predict stricture formation from circumferential submucosal scarring. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 2, 2017 Category: Pediatrics Authors: Arnold Marion, Alp Numanoglu Source Type: research
Neonatal and Pediatric Esophageal Perforation
Esophageal Perforation (EP) is a rare complication that is often iatrogenic in origin. In contrast with adult patients in whom surgical closure of the defect is preferred, non-operative treatment has become a common therapeutic approach for EP in neonates and children. Principles of management pediatric EP includes rapid diagnosis, appropriate hemodynamic monitoring and support, antibiotic therapy, total parenteral nutrition, control of extraluminal contamination and restoration of luminal integrity either through time or operative approaches. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 2, 2017 Category: Pediatrics Authors: Rebecca M. Rentea, Shawn D. St. Peter Tags: 26/2 April - Esophageal disorders Source Type: research
