Cochrane Database of Systematic Reviews

Late versus early surgical correction for congenital

diaphragmatic hernia in newborn infants (Review)
Moyer VA, Moya FR, Tibboel D, Losty PD, Nagaya M, Lally KP

Moyer VA, Moya FR, Tibboel D, Losty PD, Nagaya M, Lally KP.
Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants.
Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001695.
DOI: 10.1002/14651858.CD001695.

www.cochranelibrary.com

Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants (Review)
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]

Late versus early surgical correction for congenital

diaphragmatic hernia in newborn infants
Virginia A Moyer1 , Fernando R Moya2 , Dick Tibboel3 , Paul D Losty4 , Masahiro Nagaya5 , Kevin P Lally6
1
Academic General Pediatrics, Baylor College of Medicine and Texas Childrens Hospital, Houston, Texas, USA. 2 PLLC Director of
Neonatology, New Hanover Regional Medical Center, Wilmington, NC, USA. 3 Department of Pediatric Surgery - ICU, Sophia Childrens Hospital, Rotterdam, Netherlands. 4 Institute of Child Health, Royal Liverpool Childrens Hospital, Liverpool, UK. 5 Department
of Pediatric Surgery, Central Hospital, Kasugai, Japan. 6 University of Texas at Houston, Houston, Texas, USA

Contact address: Virginia A Moyer, Academic General Pediatrics, Baylor College of Medicine and Texas Childrens Hospital, Houston,
Texas, USA. moyer@bcm.edu.
Editorial group: Cochrane Neonatal Group.
Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 5, 2010.
Review content assessed as up-to-date: 2 February 2010.
Citation: Moyer VA, Moya FR, Tibboel D, Losty PD, Nagaya M, Lally KP. Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001695. DOI:
10.1002/14651858.CD001695.
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
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.
Objectives
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 methods
Search of MEDLINE (1966 to Sept 2003), EMBASE (1978 to Oct 2003) and the Cochrane Central Register of Controlled Trials
(CENTRAL, The Cochrane Library, Issue 3, 2003); citations search, and contact with experts in the field to locate other published
and unpublished studies.
This search was updated in 2009.
Selection criteria
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 collection and analysis
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.
Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants (Review)
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Main results
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.
Authors conclusions
There is no clear evidence which favors delayed (when stabilized) as compared with immediate (within 24 hours of birth) timing of
surgical 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.

PLAIN LANGUAGE SUMMARY

Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants
No clear evidence about when to perform surgery to correct congenital diaphragmatic hernia. Congenital diaphragmatic hernia is a
rare but often fatal condition. It occurs when a newborn babys diaphragm has a defect in it that allows abdominal organs (such as the
stomach or liver) to enter the chest and displace the lung and heart. Surgery can correct the defect, but damage to the lung may be so
severe that the baby still cannot survive. It has been thought that correcting the defect was so urgent that emergency surgery should
be performed within the first 24 hours following birth, but more recent thinking suggests that a period of stabilization before surgery
could help the lung develop. Only two trials have been done, and these provide no clear evidence to support delayed surgery over
emergency surgery.

Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants (Review)
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.