Aim This study aims to define patterns in the management of congenital diaphragmatic hernia (CDH). Methods A total of 180 delegates (77% senior surgeons) from 44 (26 European) countries completed a survey at the 2014 European Pediatric Surgeons' Association meeting. Results Overall, 34% of the surgeons work in centers that treat < 5 cases of CDH/y, 38% work in centers that treat 5 to 10 cases/y, and 28% work in centers that treat > 10 cases/y. Overall, 62% of the surgeons work in extra corporeal membrane oxygenation (ECMO) centers and 23% in fetal surgery centers. Prenatal work up and delivery: 47% surgeons request prenatal magnetic resonance imaging, 53% offer karyotyping, 22% perform a fetal intervention, 74% monitor head-to-lung ratio, and 55% administer maternal steroids. Delivery is via cesarean section for 47% surgeons, at 36 to 38 weeks for 71% surgeons, and in a tertiary care center for 94% of the surgeons. Postnatal Management A total of 76% surgeons report elective intubation, 65% start antibiotics preoperatively, and 45% administer surfactant. In case of refractory hypoxia, 66% surgeons consider ECMO with a variable course. Parenteral feeding is started preoperatively by 56% of the surgeons. Only 13% of the surgeons request contrast studies preoperatively to rule out malrotation.

malrotation, muscle flap, patch, Permacol, thoracoscopy,
European Journal of Pediatric Surgery
Department of Pediatric Surgery

Zani, A, Eaton, S, Puri, R.K, Rintala, R, Lukač, M, Bagolan, P, … Pierro, A. (2015). International Survey on the Management of Congenital Diaphragmatic Hernia. European Journal of Pediatric Surgery, 26(1), 38–46. doi:10.1055/s-0035-1564713