The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia

Nobuyuki Morikawa, Tatsuo Kuroda, Toshiro Honna, Yoshihiro Kitano, Hajime Takayasu, Yushi Ito, Tomoo Nakamura, Satoshi Nakagawa, Satoshi Hayashi, Haruhiko Sago

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background/purpose: Although the prognosis of congenital diaphragmatic hernia (CDH) is determined by the degree of pulmonary hypoplasia, there may be an occult contribution of infection to outcomes. The purpose of this study is to evaluate the effects of our new supportive therapy to prevent infectious complications on mortality and morbidity of CDH. Methods: Among 57 cases with CDH treated between 2002 and 2007, 43 prenatally diagnosed isolated cases were enrolled in this study. All patients were managed by a lung-protective strategy and delayed surgery. Since January 2006, we have optimized our perioperative care to reduce infectious complications by using peripherally inserted central catheters and restriction of invasive procedures including extracorporeal membranous oxygenation (ECMO). The survival rate, intubation period, maximum serum C-reactive protein (CRP) level, and complications were compared before and after the introduction of refined supportive therapy. Results: There were 25 cases (12 liver-up, 13 liver-down) treated before 2006 and 18 cases (8 liver-up, 10 liver-down) after 2006. ECMO was required for stabilization in five cases before 2006. The survival rates of total, liver-up, and liver-down cases improved from 60, 42, 77, to 83, 63, 100% after 2006, respectively. The intubation period was shortened from 37.8 ± 24.3 to 22.2 ± 10.8 days, and the maximum serum CRP level declined from 12.8 ± 11.5 to 2.2 ± 1.6 mg/dl after 2006. Nine cases developed sepsis before 2006 whereas no patients suffered from sepsis or pneumonia after 2006. Conclusion: The new supportive therapy with strict infection control improved survival rate of prenatally diagnosed CDH without using ECMO.

Original languageEnglish
Pages (from-to)1105-1109
Number of pages5
JournalPediatric Surgery International
Volume24
Issue number10
DOIs
Publication statusPublished - 2008 Oct
Externally publishedYes

Fingerprint

Infection Control
Survival Rate
Liver
Intubation
C-Reactive Protein
Blood Proteins
Sepsis
Perioperative Care
Lung
Congenital Diaphragmatic Hernias
Pneumonia
Therapeutics
Catheters
Morbidity
Mortality
Infection

Keywords

  • Congenital diaphragmatic hernia
  • Infection
  • Morbidity
  • Sepsis
  • Survival rate

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia. / Morikawa, Nobuyuki; Kuroda, Tatsuo; Honna, Toshiro; Kitano, Yoshihiro; Takayasu, Hajime; Ito, Yushi; Nakamura, Tomoo; Nakagawa, Satoshi; Hayashi, Satoshi; Sago, Haruhiko.

In: Pediatric Surgery International, Vol. 24, No. 10, 10.2008, p. 1105-1109.

Research output: Contribution to journalArticle

Morikawa, N, Kuroda, T, Honna, T, Kitano, Y, Takayasu, H, Ito, Y, Nakamura, T, Nakagawa, S, Hayashi, S & Sago, H 2008, 'The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia', Pediatric Surgery International, vol. 24, no. 10, pp. 1105-1109. https://doi.org/10.1007/s00383-008-2226-5
Morikawa, Nobuyuki ; Kuroda, Tatsuo ; Honna, Toshiro ; Kitano, Yoshihiro ; Takayasu, Hajime ; Ito, Yushi ; Nakamura, Tomoo ; Nakagawa, Satoshi ; Hayashi, Satoshi ; Sago, Haruhiko. / The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia. In: Pediatric Surgery International. 2008 ; Vol. 24, No. 10. pp. 1105-1109.
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abstract = "Background/purpose: Although the prognosis of congenital diaphragmatic hernia (CDH) is determined by the degree of pulmonary hypoplasia, there may be an occult contribution of infection to outcomes. The purpose of this study is to evaluate the effects of our new supportive therapy to prevent infectious complications on mortality and morbidity of CDH. Methods: Among 57 cases with CDH treated between 2002 and 2007, 43 prenatally diagnosed isolated cases were enrolled in this study. All patients were managed by a lung-protective strategy and delayed surgery. Since January 2006, we have optimized our perioperative care to reduce infectious complications by using peripherally inserted central catheters and restriction of invasive procedures including extracorporeal membranous oxygenation (ECMO). The survival rate, intubation period, maximum serum C-reactive protein (CRP) level, and complications were compared before and after the introduction of refined supportive therapy. Results: There were 25 cases (12 liver-up, 13 liver-down) treated before 2006 and 18 cases (8 liver-up, 10 liver-down) after 2006. ECMO was required for stabilization in five cases before 2006. The survival rates of total, liver-up, and liver-down cases improved from 60, 42, 77, to 83, 63, 100{\%} after 2006, respectively. The intubation period was shortened from 37.8 ± 24.3 to 22.2 ± 10.8 days, and the maximum serum CRP level declined from 12.8 ± 11.5 to 2.2 ± 1.6 mg/dl after 2006. Nine cases developed sepsis before 2006 whereas no patients suffered from sepsis or pneumonia after 2006. Conclusion: The new supportive therapy with strict infection control improved survival rate of prenatally diagnosed CDH without using ECMO.",
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AU - Honna, Toshiro

AU - Kitano, Yoshihiro

AU - Takayasu, Hajime

AU - Ito, Yushi

AU - Nakamura, Tomoo

AU - Nakagawa, Satoshi

AU - Hayashi, Satoshi

AU - Sago, Haruhiko

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N2 - Background/purpose: Although the prognosis of congenital diaphragmatic hernia (CDH) is determined by the degree of pulmonary hypoplasia, there may be an occult contribution of infection to outcomes. The purpose of this study is to evaluate the effects of our new supportive therapy to prevent infectious complications on mortality and morbidity of CDH. Methods: Among 57 cases with CDH treated between 2002 and 2007, 43 prenatally diagnosed isolated cases were enrolled in this study. All patients were managed by a lung-protective strategy and delayed surgery. Since January 2006, we have optimized our perioperative care to reduce infectious complications by using peripherally inserted central catheters and restriction of invasive procedures including extracorporeal membranous oxygenation (ECMO). The survival rate, intubation period, maximum serum C-reactive protein (CRP) level, and complications were compared before and after the introduction of refined supportive therapy. Results: There were 25 cases (12 liver-up, 13 liver-down) treated before 2006 and 18 cases (8 liver-up, 10 liver-down) after 2006. ECMO was required for stabilization in five cases before 2006. The survival rates of total, liver-up, and liver-down cases improved from 60, 42, 77, to 83, 63, 100% after 2006, respectively. The intubation period was shortened from 37.8 ± 24.3 to 22.2 ± 10.8 days, and the maximum serum CRP level declined from 12.8 ± 11.5 to 2.2 ± 1.6 mg/dl after 2006. Nine cases developed sepsis before 2006 whereas no patients suffered from sepsis or pneumonia after 2006. Conclusion: The new supportive therapy with strict infection control improved survival rate of prenatally diagnosed CDH without using ECMO.

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KW - Sepsis

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