{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:00:27Z","timestamp":1791903627374,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,9,7]],"date-time":"2015-09-07T00:00:00Z","timestamp":1441584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>The risk of recurrence of Congenital Diaphragmatic Hernia (CDH) in an era of thoracoscopic surgery is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>(1) estimate the incidence and (2) evaluate the perioperative factors associated with the symptomatic recurrence of CDH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medical records of CDH infants operated on in the neonatal period at a single\u2010tertiary hospital between January 2000 and January 2013 were retrospectively reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 119 infants with CDH, 34 (28.6%) were excluded: 17 (14.3%) died without recurrence and 17 (14.3%) presented beyond neonatal period or were followed elsewhere. Of 85 survivors, 71 infants had an open repair and 14 had a thoracoscopic repair. Eleven of 85 survivors (13%) developed a recurrence on average 19.8 weeks (range 15\u201334) after the initial repair. Of 11 recurrences, 6 had an initial thoracoscopic repair and 5 had an open repair (6\/14 [43%] vs. 5\/71 [7%]; <jats:italic>P<\/jats:italic>\u2009=\u20090.002). Two children had multiple recurrences. Statistically significant associations were found between recurrence and the presence of persistent pulmonary hypertension (PPHTN) (<jats:italic>P\u2009=\u2009<\/jats:italic>0.006), severe PPHTN (<jats:italic>P<\/jats:italic>\u2009=\u20090.002), inhaled nitric oxide, or sildenafil use for treatment of PPHTN (<jats:italic>P<\/jats:italic>\u2009=\u20090.002), need for perioperative high frequency oscillatory ventilation (HFOV) (<jats:italic>P\u2009=\u2009<\/jats:italic>0.0006), length of hospital stay (LOS) (<jats:italic>P\u2009=\u2009<\/jats:italic>0.02), duration of ventilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.016), and need for home oxygen (<jats:italic>P\u2009=\u2009<\/jats:italic>0.003). In multivariate regression analysis both the closure type and home oxygen requirement were statistically significant, independent factors predicting a recurrence (<jats:italic>P<\/jats:italic>\u2009=\u20090.04 and 0.02, respectively) but the type of surgery (thoracoscopic vs. open) only approached significance (<jats:italic>P<\/jats:italic>\u2009=\u20090.052). The recurrence rate for the seven surgeons who performed at least 5 repairs ranged from 7% to 40%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A high survival rate of 85% with a 13% incidence of symptomatic CDH recurrence was demonstrated. Potentially, improved selection of cases for thoracoscopic repair and concentrating the thoracoscopic technique amongst a dedicated team of experienced thoracoscopic surgeons may reduce the rate of recurrence of CDH. <jats:bold>Pediatr Pulmonol. 2016;51:394\u2013401<\/jats:bold>. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.23305","type":"journal-article","created":{"date-parts":[[2015,9,8]],"date-time":"2015-09-08T01:07:08Z","timestamp":1441674428000},"page":"394-401","source":"Crossref","is-referenced-by-count":47,"title":["Recurrent diaphragmatic hernia: Modifiable and non\u2010modifiable risk factors"],"prefix":"10.1002","volume":"51","author":[{"given":"Montaha M.","family":"Al\u2010Iede","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Children's Hospital at Westmead Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Karpelowsky","sequence":"additional","affiliation":[{"name":"Discipline of Paediatrics and Child Health Sydney Medical School University of Sydney New South Wales Australia"},{"name":"Department of Surgery Children's Hospital at Westmead Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic A.","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Children's Hospital at Westmead Sydney Australia"},{"name":"Discipline of Paediatrics and Child Health Sydney Medical School University of Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,9,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2004.03.009"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-3040"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2011.02.009"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1055-8586(02)00020-3"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2011.03.050"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1395486"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2013.02.005"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1071226"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(81)80113-3"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(97)90506-6"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2012.11.012"},{"key":"e_1_2_6_13_1","first-page":"1526","article-title":"Diagnosis and management of persistent pulmonary hypertension of the newborn","volume":"15","author":"Bendapudi P","year":"2015","journal-title":"Paediatr Respir Rev"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199210000-00009"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.11.048"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2009.02.043"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.28818"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2014.02.049"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181dca0e8"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2008.10.013"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2008.11.030"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.20037"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2009.10.028"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(05)80109-5"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1066490"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2007.03.018"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2011.11.054"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9306"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2004.09.037"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2013.03.012"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.11.046"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200141"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199109000-00019"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1261939"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(98)90681-9"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-008-2257-y"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3468(94)90290-9"},{"key":"e_1_2_6_38_1","first-page":"331","article-title":"Associated malformations in cases with congenital diaphragmatic hernia","volume":"19","author":"Stoll C","year":"2008","journal-title":"Genet Couns"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fppul.23305","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.23305","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T15:20:12Z","timestamp":1696519212000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.23305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9,7]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2016,4]]}},"alternative-id":["10.1002\/ppul.23305"],"URL":"https:\/\/doi.org\/10.1002\/ppul.23305","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9,7]]}}}