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Eur J Pediatr Surg
DOI: 10.1055/a-2228-6969
Original Article

The Timing of Surgery for Congenital Diaphragmatic Hernia in Infants, on or after Weaning from Extracorporeal Membrane Oxygenation: A Meta-Analysis

Minhua Lin    *
1   Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
,
Jiachi Liao   *
1   Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
,
Le Li
1   Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Abstract

Objectives We conducted a meta-analysis of trials to determine the optimal time to conduct surgery for congenital diaphragmatic hernia (CDH) in infants, on or after weaning from extracorporeal membrane oxygenation (ECMO).

Methods We searched the PubMed, Embase, Scopus, and Cochrane Library databases to identify relevant articles published prior to May 2023 in which surgery was performed to treat CDH in infants. Data were collected, and continuous data were represented by the mean difference (MD) and 95% confidence interval (CI). Dichotomous data were represented by the odds ratio (OR) and 95% CI. Review Manager V.5.4 and Stata were used to synthesize results and to assess publication bias.

Results The results showed that infants undergoing surgery after being weaned from ECMO had reduced mortality (OR, 2.40; 95% CI, 1.23–4.69; p = 0.01) and postoperative bleeding rates (OR, 16.20; 95% CI, 5.73–45.76; p < 0.00001) and reduced ECMO duration (MD, 3.47; 95% CI, 1.89–5.05; p < 0.0001) compared with those who underwent surgery while on ECMO. There was no statistically significant difference in hospital duration (MD, 5.48; 95% CI, −8.66 to 19.62; p = 0.45) or ventilator duration (MD, −1.93; 95% CI, −8.55 to 4.68; p = 0.57).

Conclusion We recommend weaning patients with CDH from ECMO before performing surgery.

Keywords

congenital diaphragmatic hernia - extracorporeal membrane oxygenation - infants - surgery - meta-analysis

* Minhua Lin and Jiachi Liao are both the first authors, and they contributed equally to the article.




Publication History

Received: 01 November 2023

Accepted: 08 December 2023

Accepted Manuscript online:
13 December 2023

Article published online:
23 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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