Article Text

Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative
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  1. Pramod Puligandla1,
  2. Erik Skarsgard2,
  3. Robert Baird2,
  4. Elena Guadagno3,
  5. Alexandra Dimmer1,
  6. Olivia Ganescu1,
  7. Nimrah Abbasi4,
  8. Gabriel Altit5,
  9. Mary Brindle6,
  10. Sairvan Fernandes2,
  11. Shyamala Dakshinamurti7,
  12. Helene Flageole8,
  13. Audrey Hebert9,
  14. Richard Keijzer10,
  15. Martin Offringa11,
  16. Dylan Patel1,
  17. Greg Ryan12,
  18. Michael Traynor13,
  19. Augusto Zani14,
  20. Priscilla Chiu15
  21. The Canadian Congenital Diaphragmatic Hernia Collaborative
  1. 1 Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
  2. 2 Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's hospital of the McGill University Health Centre, Montreal, Quebec, Canada
  4. 4 Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  5. 5 Neonatology, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
  6. 6 Department of Surgery, Section of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
  7. 7 Department of Pediatrics and Child Health, Section of Neonatology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  8. 8 Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
  9. 9 Department of Pediatrics, Division of Neonatology, Laval University, Quebec City, Quebec, Canada
  10. 10 Department of Pediatric Surgery and Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
  11. 11 Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  12. 12 Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Ontario Fetal Centre, Toronto, Ontario, Canada
  13. 13 Department of Anesthesia, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
  14. 14 Department of Surgery, Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  15. 15 Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Pramod Puligandla, Pediatric Surgery, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; pramod.puligandla{at}mcgill.ca

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.

  • Health services research
  • Intensive Care Units, Neonatal
  • Intensive Care Units, Paediatric
  • Neonatology
  • Paediatrics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • X @DrPuligandla, @GuadagnoElena, @CardioNeo

  • Collaborators The Canadian Congenital Diaphragmatic Hernia Collaborative.

  • Contributors A three-member steering committee (PP, ES, RB) was formed to oversee the CDH Collaborative’s guideline development process, to finalise the guideline panel membership and contributors to the literature reviews, to critically appraise all materials generated during the evidence review process, oversee the final guidelines endorsement process and prepare the manuscript. PP acted as guarantor. They were specifically involved in the preparation of sections on haemodynamics (PP), ECLS (RB), non-primary surgical repair (ES), type of surgical repair (ES), repair on ECLS (ES/PP), and pain control and analgesia (ES). EG was the research director for the project who oversaw its design, the literature search and screening, as well as the editing of the final revised version of the manuscript and supplemental materials. AD was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on surgery on ECLS, as well as the revision of the final submitted manuscript. OG was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on haemodynamics, as well as the revision of the final submitted manuscript. NA was involved with the critical appraisal and preparation of the sections on prenatal diagnosis and fetal therapy, as well as revision of the final submitted manuscript. GA was involved with the literature search and abstract screening, the critical appraisal and preparation of the sections on echocardiography, role of PGE and target pulmonary vasodilator therapy, as well as the revision of the final submitted manuscript. MB was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on surgical readiness, as well as the revision of the final submitted manuscript. SF was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on type of surgical repair, as well as the revision of the final submitted manuscript. SD was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on ventilation, as well as the revision of the final submitted manuscript. HF was involved with the critical appraisal and preparation of the section on gastro-oesophageal reflux as well as the revision of the final submitted manuscript. AH was involved with the literature search and abstract screening, the critical appraisal and preparation of the sections on echocardiography, role of PGE and target pulmonary vasodilator therapy, as well as the revision of the final submitted manuscript. RK was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on ECLS as well as the revision of the final submitted manuscript. MO was involved in the concept and design of the work, as the facilitator for our Delphi consensus process, as well as the revision of the final submitted manuscript. DP was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on role of ECLS, as well as the revision of the final submitted manuscript. GR was involved with the critical appraisal and preparation of the sections on prenatal diagnosis and fetal therapy, as well as the revision of the final submitted manuscript. MT was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on ventilation, as well as the revision of the final submitted manuscript. AZ was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on ECLS as well as the revision of the final submitted manuscript. PC was involved with the literature search and abstract screening, the critical appraisal and preparation of the section on long-term follow-up, as well as the revision of the final submitted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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