Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States; Department of Surgery, University of California Irvine Medical Center, 505 S. Main St, #225, Orange, CA 92868, United States.
David Geffen School of Medicine at UCLA, Mattel Children's Hospital at UCLA, Los Angeles, CA, United States.
Semin Perinatol. 2020 Feb;44(1):151166. doi: 10.1053/j.semperi.2019.07.005. Epub 2019 Jul 30.
Congenital diaphragmatic hernia (CDH) is the most common indication for extra-corporeal membrane oxygenation (ECMO) for neonatal respiratory failure. CDH management is evolving with advanced prenatal diagnostic imaging modalities. The risk profiles of infants receiving ECMO for CDH are shifting towards higher risk. Many clinicians are developing and following clinical practice guidelines to standardize and optimize the care of CDH neonates. Despite these efforts, there are significant differences in the practice patterns among ECMO centers as to how and when they choose to initiate ECMO for CDH, when they believe repair is safe, as well as many other nuances that are based on center experience or style. The purpose of this report is to summarize our current understanding of the new and recent developments regarding management of infants with CDH managed with ECMO.
先天性膈疝 (CDH) 是新生儿呼吸衰竭行体外膜肺氧合 (ECMO) 治疗的最常见指征。随着产前诊断成像技术的进步，CDH 的管理也在不断发展。接受 ECMO 治疗 CDH 的婴儿的风险特征正朝着更高的风险转移。许多临床医生正在制定和遵循临床实践指南，以规范和优化 CDH 新生儿的护理。尽管做出了这些努力，但 ECMO 中心在如何以及何时选择启动 ECMO 治疗 CDH、何时认为修复是安全的以及许多其他基于中心经验或风格的细微差别方面，其治疗模式仍存在显著差异。本报告的目的是总结我们目前对 ECMO 治疗 CDH 婴儿管理方面的新进展和最新发展的理解。
