- The new guideline for the treatment of babies diagnosed with congenital diaphragmatic hernia, aims to help physicians to manage the conditionfrom the time of diagnosis to their teenage years.
- Congenital diaphragmatic hernia is a "hole" in the diaphragmatic muscle that separates the chest from the abdominal cavity. Through this hole or hernia the intestines can prolapse into the chest cavity causing serious problems including death.
- The guidelines have been created to provide standardized care of the kids through their three phases of childhood: prenatal, postnatal and teenage years.
Diaphragmatic Hernia Treatment in children can now be improved by revising the old Canadian guidelines and to provide standardized care finds a new study.
This condition usually requires the expertise of a variety of specialists in addition to primary care physicians. The findings of this study are published in the Canadian Medical Association Journal (CMAJ)
‘New recommendations have been made to improve standardized care from the time of diagnosis (i.e.) during pregnancy to the teen years of the patient. It also covers all aspects of care rather than specific lung problems, which have focused on in the existing guideline.
Improvements in neonatal care have improved survival rates of these babies from 50% to 80% in the last 30 years, but survivors can experience significant long-term health issues that affect feeding, growth and brain development as well as the lungs, heart and thoracic cage.
The lack of "best practices" on how to manage this complex condition leads to significant variability in care across Canada. The guideline was created to provide standardized management through three phases: prenatal, postnatal and childhood/teen stages of life.
The guideline was created to provide standardized management through three phases: prenatal, postnatal and childhood/teen stages of life. The condition requires the expertise of a variety of specialists in addition to primary care physicians. The lack of "best practices" on how to manage this complex condition leads to significant variability in care across Canada.
"We saw this as an opportunity to improve outcomes for children with a congenital diaphragmatic hernia by standardizing care across Canada," says Dr. Pramod Puligandla, Montreal Children's Hospital, Montreal, Quebec, and the project lead of the Canadian Congenital Diaphragmatic Hernia Collaborative that developed the guideline. "We hope this evidence-based guideline will be useful to all clinicians involved in the care of these infants."
The authors consulted existing recommendations before creating their own and note that the new Canadian guidelines are more in-depth than the guidelines from Europe. The new guidelines also cover all aspects of care for congenital diaphragmatic hernia rather than specific lung problems, which recent guidelines from the American Heart Association/American Thoracic Society focus on.
A key recommendation from the Canadian guidelines is long-term observation and management.
"Long-term disability surveillance is essential, especially in high-risk patients, and should be managed by interdisciplinary teams of primary care physicians, pediatricians, pediatric subspecialists, pediatric surgeons and other allied health professionals," the authors conclude.
- Pramod S. Puligandla, Erik D. Skarsgard, Martin Offringa, Ian Adatia, Robert Baird, et.al. Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline, Canadian Medical Association Journal (2018).DOI: https://doi.org/10.1503/cmaj.170206