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Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants

Overview of attention for article published in Cochrane database of systematic reviews, October 2000
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Title
Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants
Published in
Cochrane database of systematic reviews, October 2000
DOI 10.1002/14651858.cd001695
Pubmed ID
Authors

Virginia A Moyer, Fernando R Moya, Dick Tibboel, Paul D Losty, Masahiro Nagaya, Kevin P Lally

Abstract

Congenital diaphragmatic hernia, although rare (1 per 2-4,000 births), is associated with high mortality and cost. Opinion regarding the timing of surgical repair has gradually shifted from emergent repair to a policy of stabilization using a variety of ventilatory strategies prior to operation. Whether delayed surgery is beneficial remains controversial. To summarize the available data regarding whether surgical repair in the first 24 hours after birth rather than later than 24 hours of age improves survival to hospital discharge in infants with congenital diaphragmatic hernia who are symptomatic at or immediately after birth. Search of Medline (1966-1999), Embase (1978-1999) and the Cochrane databases using the terms "congenital diaphragmatic hernia" and "surg*"; citations search, and contact with experts in the field to locate other published and unpublished studies. Studies were eligible for inclusion if they were randomized or quasi-randomized trials that addressed infants with CDH who were symptomatic at or shortly after birth, comparing early (<24 hours) vs late (>24 hours) surgical intervention, and evaluated mortality as the primary outcome. Data were collected regarding study methods and outcomes including mortality, need for ECMO and duration of ventilation, both from the study reports and from personal communication with investigators. Analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. Two trials met the pre-specified inclusion criteria for this review. Both were small trials (total n<90) and neither showed any significant difference between groups in mortality. Meta-analysis was not performed because of significant clinical heterogeneity between the trials. There is no clear support for either immediate (within 24 hours of birth) or delayed (until stabilized) repair of congenital diaphragmatic hernia, but a substantial advantage to either one cannot be ruled out. A large, multicenter randomized trial would be needed to answer this question.

Mendeley readers

The data shown below were compiled from readership statistics for 78 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 2 3%
Japan 1 1%
India 1 1%
Australia 1 1%
Unknown 73 94%

Demographic breakdown

Readers by professional status Count As %
Researcher 12 15%
Student > Bachelor 11 14%
Student > Ph. D. Student 10 13%
Student > Master 8 10%
Student > Postgraduate 8 10%
Other 22 28%
Unknown 7 9%
Readers by discipline Count As %
Medicine and Dentistry 44 56%
Social Sciences 4 5%
Nursing and Health Professions 3 4%
Agricultural and Biological Sciences 2 3%
Biochemistry, Genetics and Molecular Biology 1 1%
Other 5 6%
Unknown 19 24%