Arch Dis Child Fetal Neonatal Ed

. 2023 Oct 25:fetalneonatal-2023-325865.

 doi: 10.1136/archdischild-2023-325865. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/37879884/

Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative

Pramod Puligandla ¹, Erik Skarsgard ², Robert Baird ², Elena Guadagno ³, Alexandra Dimmer ⁴, Olivia Ganescu ⁴, Nimrah Abbasi ⁵, Gabriel Altit ⁶, Mary Brindle ⁷, Sairvan Fernandes ², Shyamala Dakshinamurti ⁸, Helene Flageole ⁹, Audrey Hebert ¹⁰, Richard Keijzer ¹¹, Martin Offringa ¹², Dylan Patel ⁴, Greg Ryan ¹³, Michael Traynor ¹⁴, Augusto Zani ¹⁵, Priscilla Chiu ¹⁶; Canadian Congenital Diaphragmatic Hernia Collaborative

Affiliations expand

• PMID: 37879884
• DOI: 10.1136/archdischild-2023-325865

Abstract

Objective: The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a ‘living document’.

Design and main outcome measures: Critical appraisal of CDH literature adhering to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence accumulated between 1 January 2017 and 30 August 2022 was analysed to inform changes to existing or the development of new CDH care recommendations. Strength of consensus was also determined using a modified Delphi process among national experts in the field.

Results: Of the 3868 articles retrieved in our search that covered the 15 areas of CDH care, 459 underwent full-text review. Ultimately, 103 articles were used to inform 20 changes to existing recommendations, which included aspects related to prenatal diagnosis, echocardiographic evaluation, pulmonary hypertension management, surgical readiness criteria, the type of surgical repair and long-term health surveillance. Fifteen new CDH care recommendations were also created using this evidence, with most related to the management of pain and the provision of analgesia and neuromuscular blockade for patients with CDH.

Conclusions: The 2023 Canadian CDH Collaborative’s clinical practice guideline update provides a management framework for infants and children with CDH based on the best available evidence and expert consensus.

Keywords: Health services research; Intensive Care Units, Neonatal; Intensive Care Units, Paediatric; Neonatology; Paediatrics.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.