Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee

摘要: Abstract Objective Variable management practices complicate the identification of optimal strategies for infants with congenital diaphragmatic hernia (CDH). This review critically appraises available evidence to provide recommendations. Methods Six questions regarding CDH were generated. English language articles published between 1980 and 2014 compiled after searching Medline, Cochrane, Embase Web Science. Given paucity literature on subject, all studies irrespective their rank in levels hierarchy included. Results Gentle ventilation permissive hypercapnia provides best outcomes. Initial high frequency may be considered but its overall efficacy is unproven. Routine inhaled nitric oxide (iNO) or other medical adjuncts acute, severe pulmonary hypertension demonstrate no benefit. Evidence does not support routine administration pre- postnatal glucocorticoids. Mode extracorporeal membrane oxygenation (ECMO) has little bearing While timing repair impact outcomes, early ECMO benefits. Open leads significantly fewer recurrences. Polytetrafluoroethylene (PTFE) most durable patch material. Conclusions Limited high-level prevents development robust guidelines CDH. Prospective, multi-institutional are needed identify optimize