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Pulmonary Hypoplasia
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Indications for the FETO trial (fetal tracheal occlusion) are liver herniation and lung-to-head ratio (LHR) greater than 0.9 — Wolfan, Controversies in Congenital Diaphragmatic Hernia: Update Course 2018 · 41:18
Controversies in Congenital Diaphragmatic Hernia: Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Dr. Mark Wulkan discusses controversies in congenital diaphragmatic hernia including advantages of open versus minimally invasive repair (with visualization of technique), timing of CDH rep
video41:42 · Sep 2018
Approach and component separation for suture closure and underlay mesh...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, directors DrsTodd Ponsky, Robert Parry, and Jacob Langer, along with faculty including Drs David van der Zee, Suad
video31:03 · Sep 2018
Tricks - Omphalocele - Approach & Component Separation For Suture Closure &...
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This segment displays a presentation of omphalocele, separation of components and closure of the abdominal wall. The topics discussed include incision placement, component separation, patch closure, ideal time to operate, early versus delay
video32:30 · Nov 2018
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
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Dr. Yan Deprest, Professor of Obstetrics GYN, University Hospitals Gasthuisberg. Leuven, Belgium, discusses fetoscopic endoluminal tracheal occlusion. His presentation provides insight on the percutaneous procedure, trocar insertion, delive
video2:29:16 · Jan 2019
The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues — Charlie Stolar, Congenital Diaphragmatic Hernia with Dr. Charlie Stolar · 5:24
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
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Dr Charlie Stolar discusses key points of CDH with Dr. Todd Ponsky. EDITED BY NICHOLAS BRUNS, MD and IAN GLENN, MD.In this episode, Dr. Charles Stolar from Columbia University College of Physicians and Surgeons and California Pediatric Sur
podcast1:22:05 · Dec 2020
Expert statements from the recordings in this collection.
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies
Charlie Stolar2:45
CDH diagnosis is typically made at the 20-week anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart
Charlie Stolar3:37
CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side
Charlie Stolar4:14
At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation
Charlie Stolar4:23
CDH is a field defect; the most common neonatal comorbidity is foregut motility difficulty
Charlie Stolar4:39
CDH is a medical physiologic emergency but not a surgical emergency
Charlie Stolar5:00
The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues
Antenatal interventions for CDH are no better than investigational and experimental at best
Babies with CDH should be born at a full-service children's facility with ECMO capability; maybe 10-15% will benefit from ECMO
In single-center experiences, presence of liver in the chest or stomach in the chest is of no prognostic value
Charlie Stolar8:31
Lung-to-head ratio is of limited prognostic value except when very low (less than 0.8), where prognosis is concerning
Charlie Stolar8:42
Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis
Charlie Stolar9:07
If shown 100 children with CDH, 80-85% will survive to become teenagers
Charlie Stolar10:13
Antenatal steroids have tremendous value for preterm labor under 35 weeks but most CDH babies are near-term (37-39 weeks) where steroid role is arguable
Charlie Stolar10:37
Exit to ECMO for CDH is nonsense; it moves the goalposts on almost certainly non-viable babies
We are born with about 1/2 to 2/3 of our full complement of alveoli and can grow the balance sometime after birth
Charlie Stolar13:00
Initial evaluation of newborn with CDH includes looking for morphology, associated anomalies, respiratory distress, pre- and post-ductal oxygen gradients, and early cardiac echo for right heart function
Charlie Stolar14:45
Not every baby with CDH needs or is a candidate for ECMO; approximately 5% have insufficient lung to support life based on inability to saturate preductal blood
Charlie Stolar15:55
ECMO is a drug delivery system for oxygen; indication is when end organs aren't getting enough oxygen despite best care
Charlie Stolar17:06
The best way to assess end-organ function is urine output
Charlie Stolar17:44
ECMO indication is typically oxygenation index in excess of 40 for 4 hours or more
All therapy is guided by preductal oximetry, not postductal; if preductal saturation is 90% (PaO2 ~65 torr), the brain is doing fine with fetal hemoglobin
Charlie Stolar19:06
When managing dropping preductal saturation, first ensure adequate hemoglobin and circulating volume, then increase FiO2 or ventilator pressure, but avoid trying to control PCO2 as this will destroy the lungs
Charlie Stolar20:25
Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today
CDH babies are not paralyzed during ventilation; minimal sedation is used and babies should be awake and breathing spontaneously
Charlie Stolar21:56
Initial conventional ventilator settings (IMV rate ~40, peak pressure 25-28, PEEP ~5) are not tolerated by most CDH babies
Charlie Stolar22:15
Unconventional ventilation mode for CDH uses high rate (100 breaths/min), low peak pressure (turned down to zero due to stacking), and high gas flow rate with permissive hypercapnia
Charlie Stolar22:53
High-frequency oscillatory ventilation (HFOV) as rescue therapy rarely spares CDH babies from ECMO; when they get out the oscillator, it's time to prime an ECMO circuit
Charlie Stolar24:30
Nitric oxide is a waste of money for CDH; it's terrific for premature babies with immature lung disease but of no value in CDH
The best drug for CDH is oxygen