# Congenital Diaphragmatic Hernia — GCMD Library living collection

Everything in the library about CDH — built automatically from dossiers that name it.

Updated: n/a · 44 episodes · 783 cited statements

## Episodes
### Acute Management
- [CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002) — video · 10:45 · [machine version](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002.md)
- [Update Course Rewind: When & How to Operate CDH Patients on ECMO 2024](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772) — video · 4:44 · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772.md)
- [Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at Cincinnati Children's](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129) — video · 5:22 · [machine version](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129.md)

### Surgical Management
- [Controversies in Congenital Diaphragmatic Hernia: Update Course 2018](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338) — video · 41:42 · [machine version](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338.md)
- [Challenges in Diaphragmatic Hernia Repair: Update Course 2016](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559) — video · 44:15 · [machine version](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559.md)
- [CDH - MIS vs. Open: Update Course 2015](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998) — video · 5:57 · [machine version](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998.md)
- [CDH-ECMO Routine Patient Preoperative Workup, Timing, Technique: Update...](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003) — video · 3:31 · [machine version](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003.md)
- [Fetoscopic Endoluminal Tracheal Occlusion (FETO)](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330) — podcast · 5:54 · [machine version](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330.md)
- [Update Course Rewind: When & How to Operate CDH Patients on ECMO 2024 Part 2](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890) — video · 4:55 · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890.md)
- [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569) — video · 4:30 · [machine version](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569.md)
- [Fetoscopic Endoluminal Tracheal Occlusion (FETO) Procedure: Step-by-Step Guide with Dr. Beth Rymeski](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010) — video · 4:30 · [machine version](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010.md)

### Complications
- [Neonatal Gastric Volvulus with Dr. Jason Frischer](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494) — podcast · 11:17 · [machine version](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494.md)

### Evidence & Research
- [Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689) — podcast · 16:50 · [machine version](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689.md)
- [Best of the Best in Pediatric Surgery Winner Announcement](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321) — video · 8:26 · [machine version](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321.md)
- [CAPS - Administration of amniotic fluid stem cell extracellular vesicles regenerates the lung epithelium in fetal rats with CDH at translationally relevant developmental stages - Kasra Khalaj](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421) — video · 7:42 · [machine version](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421.md)
- [EUPSA - MicroRNAs in amniotic fluid stem cellextracellular vesicles modulate lung development in experimental congenital diaphragmatic hernia - Kasra Khalaj](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430) — video · 10:03 · [machine version](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430.md)
- [EUPSA - Circular RNA profiles isolated from amniotic fluidscan distinguish between CDH survivors and non-survivers - Richard Wagner](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431) — video · 9:12 · [machine version](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431.md)
- [IFMSS 2019 Clinical Studies](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109) — podcast · 19:13 · [machine version](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109.md)
- [BOB in Ped Surg 2023 - AAP Winner - Shelby Sferra, MD](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321) — video · 11:50 · [machine version](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321.md)
- [BOB in Ped Surg 2023 - EUPSA Winner - Dr. Rebeca Figueira](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326) — video · [machine version](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326.md)
- [BOB in Ped Surg 2023 - CAPS Winner - Christina Theodorou, MD](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327) — video · [machine version](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327.md)
- [BOB Winner Presentation - Dr. Rebeca Figueira - EUPSA](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339) — video · [machine version](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339.md)
- [BOB Ped Surg 2023 - Shelby Sferra, AAP  - Presentation](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345) — video · 5:10 · [machine version](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345.md)
- [BOB Ped Surg 2023 - Christina Theodorou, CAPS  - Presentation](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346) — video · [machine version](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346.md)
- [CDH Live Webinar Series Part 1: Research: Lung Compression in CDH Generates Cellular Chronic Hypoxia and Energy Failure](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641) — video · [machine version](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641.md)
- [Case-Based Journal Review: Congenital Diaphragmatic Hernia 2023](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336) — podcast · 19:20 · [machine version](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336.md)
- [El momento de la reparación de la HDC en ECMO influye en el riesgo de hemorragia quirúrgica](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539) — video · [machine version](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539.md)
- [Yuichiro Miyake, MD - Best of the Best in Pediatric Surgery 2024](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010) — video · 7:20 · [machine version](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010.md)
- [Giussepe Cala, PhD candidate - Best of the Best in Pediatric Surgery 2024](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017) — video · 7:27 · [machine version](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017.md)
- [Kasra Khalaj, MSc, PhD - Best of the Best in Pediatric Surgery 2024](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024) — video · 7:16 · [machine version](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024.md)
- [Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334) — video · 0:59 · [machine version](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334.md)
- [Dr. Marietta Jank - Best of the Best in Pediatric Surgery 2025](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039) — video · 8:13 · [machine version](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039.md)
- [Dr. Adriana Dekirmendjian - Best of the Best in Pediatric Surgery 2025](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040) — video · 9:30 · [machine version](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040.md)
- [Quick Literature Updates Episode 20](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554) — video · 4:03 · [machine version](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554.md)

### Case-Based Learning
- [Severe Congenital Diaphragmatic Hernia (CDH) Case: FETO Management & Unexpected Findings with Dr. Beth Rymeski](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011) — video · 3:51 · [machine version](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011.md)
- [FETO for Late-Diagnosed Severe Congenital Diaphragmatic Hernia (CDH) at Cincinnati Children's with Dr. Beth Rymeski](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012) — video · 4:55 · [machine version](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012.md)

### In-Depth Reviews
- [Congenital Diaphragmatic Hernia with Dr. Charlie Stolar](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952) — podcast · 1:22:05 · [machine version](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952.md)
- [Congenital Diaphragmatic Hernia with Dr. Charlie Stolar](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303) — podcast · 1:22:05 · [machine version](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303.md)
- [Update Course Rewind: 2024 Top Ten Key Takeaways](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md)
- [Congenital Diaphragmatic Hernias (CDH): Improving Outcomes with Advanced Imaging & Nutrition](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113) — video · 5:30 · [machine version](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113.md)

### Emerging & Future Directions
- [Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025) — video · 2:29:16 · [machine version](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025.md)
- [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570) — video · 4:30 · [machine version](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570.md)

### Patient & Family Education
- [What is Congenital Diaphragmatic Hernia (CDH)? An ERNICA animation for parents and families](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810) — video · 3:14 · [machine version](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810.md)

### Long-Term Care
- [Transition of Care - Alcohol and Smoking](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648) — video · 4:00 · [machine version](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648.md)

## Chapters
- [0:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=0) Prenatal Counseling and Diagnosis (Ep 8)
- [7:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=434) Initial Neonatal Management and Respiratory Strategy (Ep 8)
- [17:48](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1068) ECMO Indications and Contraindications (Ep 8)
- [29:21](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1761) ECMO Technical Considerations (Ep 8)
- [36:24](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2184) Timing of Surgical Repair (Ep 8)
- [46:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2800) Surgical Approach: Open vs Thoracoscopic (Ep 8)
- [53:56](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3236) Technical Aspects of Repair (Ep 8)
- [59:19](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3559) Postoperative Management and Chest Tubes (Ep 8)
- [69:28](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4168) Long-term Complications and Follow-up (Ep 8)
- [74:54](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4494) Recurrence and Right-sided Hernias (Ep 8)
- [0:00](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=0) Introduction and Study Design (Ep 31)
- [0:22](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=22) Key Findings (Ep 31)
- [0:46](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) Conclusion (Ep 31)
- [0:00](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=0) Introduction and Case 1: Timing of Repair in Stable CDH (Ep 1)
- [4:31](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=271) Surgical Approach: MIS versus Open Repair (Ep 1)
- [7:50](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=470) Technical Aspects of Thoracoscopic CDH Repair (Ep 1)
- [17:47](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1067) Patch Materials and Recurrence Prevention (Ep 1)
- [25:02](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1502) Case 2: ECMO Management and Repair Timing (Ep 1)
- [30:27](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1827) ECMO Repair Strategies and David Kays' Results (Ep 1)
- [36:14](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2174) Redo Repairs, Muscle Flaps, and Fetal Intervention (Ep 1)
- [0:00](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=0) Introduction and App Promotion (Ep 15)
- [0:42](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=42) Epidemiology and Associated Anomalies (Ep 15)
- [1:51](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=111) Acute vs Chronic Presentation and Anatomic Basis (Ep 15)
- [3:41](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=221) Types of Gastric Volvulus: Organoaxial and Mesenteroaxial (Ep 15)
- [4:58](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=298) Clinical Presentation and Diagnostic Workup (Ep 15)
- [6:38](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=398) Surgical Management Principles (Ep 15)
- [7:51](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=471) Case 1: CDH with Intraoperative Volvulus (Ep 15)
- [9:03](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=543) Case 2: Acute Presentation in Healthy Term Infant (Ep 15)
- [10:44](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=644) Closing Remarks (Ep 15)
- [0:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=0) Prenatal Counseling and Diagnosis (Ep 3)
- [7:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=434) Initial Stabilization and Respiratory Management (Ep 3)
- [18:38](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1118) ECMO Indications, Cannulation, and Management (Ep 3)
- [33:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2025) ECMO Complications and Futility (Ep 3)
- [45:31](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2731) Surgical Repair Timing and Approach (Ep 3)
- [53:56](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3236) Surgical Technique and Technical Pearls (Ep 3)
- [59:19](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3559) Thoracoscopic Approach and Chest Tube Controversy (Ep 3)
- [69:28](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4168) Postoperative Management and Long-term Complications (Ep 3)
- [74:54](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4494) Recurrence and Right-sided Hernias (Ep 3)
- [0:00](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=0) Introduction and FETO Technique for Congenital Diaphragmatic Hernia (Ep 7)
- [23:20](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1400) FETO Trial Design and Outcomes (Ep 7)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies — Charlie Stolar (epidemiological) [Ep 8 · 2:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=165)
- CDH diagnosis is typically made at the 20-week anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart — Charlie Stolar (clinical) [Ep 8 · 3:37](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=217)
- CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side — Charlie Stolar (clinical) [Ep 8 · 4:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=254)
- At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation — Charlie Stolar (clinical) [Ep 8 · 4:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=263)
- CDH is a field defect; the most common neonatal comorbidity is foregut motility difficulty — Charlie Stolar (clinical) [Ep 8 · 4:39](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=279)
- CDH is a medical physiologic emergency but not a surgical emergency — Charlie Stolar (clinical) [Ep 8 · 5:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=300)
- The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues — Charlie Stolar (guideline) [Ep 8 · 5:24](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=324)
- Antenatal interventions for CDH are no better than investigational and experimental at best — Charlie Stolar (opinion) [Ep 8 · 6:35](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=395)
- Babies with CDH should be born at a full-service children's facility with ECMO capability; maybe 10-15% will benefit from ECMO — Charlie Stolar (guideline) [Ep 8 · 7:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=443)
- In single-center experiences, presence of liver in the chest or stomach in the chest is of no prognostic value — Charlie Stolar (clinical) [Ep 8 · 8:31](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=511)
- Lung-to-head ratio is of limited prognostic value except when very low (less than 0.8), where prognosis is concerning — Charlie Stolar (clinical) [Ep 8 · 8:42](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=522)
- Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis — Charlie Stolar (clinical) [Ep 8 · 9:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=547)
- If shown 100 children with CDH, 80-85% will survive to become teenagers — Charlie Stolar (epidemiological) [Ep 8 · 10:13](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=613)
- Antenatal steroids have tremendous value for preterm labor under 35 weeks but most CDH babies are near-term (37-39 weeks) where steroid role is arguable — Charlie Stolar (clinical) [Ep 8 · 10:37](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=637)
- Exit to ECMO for CDH is nonsense; it moves the goalposts on almost certainly non-viable babies — Charlie Stolar (opinion) [Ep 8 · 12:06](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=726)
- We are born with about 1/2 to 2/3 of our full complement of alveoli and can grow the balance sometime after birth — Charlie Stolar (clinical) [Ep 8 · 13:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=780)
- Initial evaluation of newborn with CDH includes looking for morphology, associated anomalies, respiratory distress, pre- and post-ductal oxygen gradients, and early cardiac echo for right heart function — Charlie Stolar (clinical) [Ep 8 · 14:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=885)
- Not every baby with CDH needs or is a candidate for ECMO; approximately 5% have insufficient lung to support life based on inability to saturate preductal blood — Charlie Stolar (clinical) [Ep 8 · 15:55](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=955)
- ECMO is a drug delivery system for oxygen; indication is when end organs aren't getting enough oxygen despite best care — Charlie Stolar (clinical) [Ep 8 · 17:06](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1026)
- The best way to assess end-organ function is urine output — Charlie Stolar (clinical) [Ep 8 · 17:44](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1064)
- ECMO indication is typically oxygenation index in excess of 40 for 4 hours or more — Charlie Stolar (guideline) [Ep 8 · 18:21](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1101)
- All therapy is guided by preductal oximetry, not postductal; if preductal saturation is 90% (PaO2 ~65 torr), the brain is doing fine with fetal hemoglobin — Charlie Stolar (clinical) [Ep 8 · 19:06](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1146)
- When managing dropping preductal saturation, first ensure adequate hemoglobin and circulating volume, then increase FiO2 or ventilator pressure, but avoid trying to control PCO2 as this will destroy the lungs — Charlie Stolar (clinical) [Ep 8 · 20:25](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1225)
- Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today — Charlie Stolar (opinion) [Ep 8 · 21:38](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1298)
- CDH babies are not paralyzed during ventilation; minimal sedation is used and babies should be awake and breathing spontaneously — Charlie Stolar (clinical) [Ep 8 · 21:56](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1316)
- Initial conventional ventilator settings (IMV rate ~40, peak pressure 25-28, PEEP ~5) are not tolerated by most CDH babies — Charlie Stolar (clinical) [Ep 8 · 22:15](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1335)
- Unconventional ventilation mode for CDH uses high rate (100 breaths/min), low peak pressure (turned down to zero due to stacking), and high gas flow rate with permissive hypercapnia — Charlie Stolar (clinical) [Ep 8 · 22:53](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1373)
- High-frequency oscillatory ventilation (HFOV) as rescue therapy rarely spares CDH babies from ECMO; when they get out the oscillator, it's time to prime an ECMO circuit — Charlie Stolar (clinical) [Ep 8 · 24:30](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1470)
- Nitric oxide is a waste of money for CDH; it's terrific for premature babies with immature lung disease but of no value in CDH — Charlie Stolar (opinion) [Ep 8 · 25:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1545)
- The best drug for CDH is oxygen — Charlie Stolar (opinion) [Ep 8 · 26:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1567)
- ECMO gestational age limit has been pushed from 36 weeks down to 35, maybe 34 weeks; below 32 weeks the intracranial hemorrhage rate takes off and neurologic outcomes become poor — Charlie Stolar (clinical) [Ep 8 · 26:22](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1582)
- The smallest ECMO arterial cannula is about 8 French; getting adequate flow out of small cannulas is problematic due to resistance related to both length and diameter — Charlie Stolar (clinical) [Ep 8 · 27:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1660)
- For ECMO candidacy, it's the gestational age that matters for intracranial hemorrhage risk (germinal matrix), not the size; size becomes an issue only when cannulas don't fit — Charlie Stolar (clinical) [Ep 8 · 28:15](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1695)
- The broad principle for ECMO candidacy is: do you have a reversible condition? Can you get out with reasonable confidence once you start? — Charlie Stolar (clinical) [Ep 8 · 28:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1725)
- VV ECMO is terrific if the heart works but problematic in CDH because heart function is often depressed and it's hard to get the cannula in with the shifted mediastinum — Charlie Stolar (clinical) [Ep 8 · 30:27](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1827)
- VV ECMO is for less sick patients who aren't in extremis; most CDH babies are sicker and do better on VA ECMO — Charlie Stolar (clinical) [Ep 8 · 31:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1860)
- VA bypass is basically dialing in a PaO2; VV has mixing issues, cannula position concerns, and is more annoying to manage — Charlie Stolar (clinical) [Ep 8 · 31:53](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1913)
- Echo guidance during ECMO cannulation is really helpful with the shifted mediastinum; the arterial cannula can go out the subclavian artery or the venous cannula into the innominate vein — Charlie Stolar (clinical) [Ep 8 · 32:17](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1937)
- If the arterial cannula goes out the subclavian artery, you'll have a well-perfused hand and think preductal sats look good, but the baby isn't seeing the oxygen — Charlie Stolar (clinical) [Ep 8 · 33:01](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1981)
- Using a guide wire to position the venous cannula into the right atrium is helpful when the mediastinum is distorted — Charlie Stolar (clinical) [Ep 8 · 33:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2003)
- Use 3 stay sutures (5-0 Prolene, rubber-shod) to lift the venotomy and arteriotomy open to avoid shearing off the intima and creating a false passage — Charlie Stolar (clinical) [Ep 8 · 33:55](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2035)
- In the first hours on ECMO, hyperkalemia can cause cardiac arrest if blood isn't washed; just perfuse through it and give calcium — Charlie Stolar (clinical) [Ep 8 · 34:47](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2087)
- ECMO flow must be increased slowly over 45-90 minutes to reduce intracranial hemorrhage incidence — Charlie Stolar (clinical) [Ep 8 · 34:55](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2095)
- Target VA ECMO flow is 100-125 cc/kg/min, which is about 80% of cardiac output assuming an open duct — Charlie Stolar (clinical) [Ep 8 · 35:10](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2110)
- At target ECMO flow, preductal saturation will be good and mixed venous (from venous drainage) will come up to 65-70% — Charlie Stolar (clinical) [Ep 8 · 35:29](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2129)
- Regular cardiac echos during ECMO weaning are important to assess right heart function, dilation, tricuspid regurgitation, and pulmonary outflow tract jet — Charlie Stolar (clinical) [Ep 8 · 36:12](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2172)
- The hyperoxia test (turning ventilator FiO2 up to 1.0) demonstrates if the baby can use their lungs; if PaO2 rises, it gives courage to begin weaning ECMO — Charlie Stolar (clinical) [Ep 8 · 36:34](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2194)
- For babies unweanable from ECMO after 2+ weeks at high flow, ensure they are maximally dried out (bone dry, eyes sucked into head), making good urine, with good labs and chest X-ray before considering on-ECMO repair — Charlie Stolar (clinical) [Ep 8 · 38:18](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2298)
- Repairing the hernia on ECMO is unusual to get you out of trouble; the problem is lung growth arrest at 14-15 weeks gestation, not that bowel is in the chest — Charlie Stolar (clinical) [Ep 8 · 39:05](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2345)
- Heparin inhibits conversion of fibrinogen to fibrin, so only platelets (beat-up ones) are making clot; platelet thrombus lifespan is 48-72 hours — Charlie Stolar (clinical) [Ep 8 · 40:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2440)
- If operating on ECMO, you have about 48-72 hours to decannulate before bleeding starts; operate when nearly weanable (20 cc/kg/min), expect 1 day of post-op deterioration, then 2-3 days to get off — Charlie Stolar (clinical) [Ep 8 · 41:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2467)
- Operating off ECMO means the baby will get stiff post-operatively, pulmonary hypertension may relapse, and you risk needing a second ECMO run — Charlie Stolar (clinical) [Ep 8 · 41:51](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2511)
- When operating on ECMO, load with Amicar preoperatively, do abdominal approach, use low threshold for patch to avoid tension, place Jackson-Pratt drain under patch, and place chest tube — Charlie Stolar (clinical) [Ep 8 · 42:39](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2559)
- Futility on ECMO begins to rear its head after 2-3 weeks; it becomes easier to discuss withdrawal if there's been a CNS event like intracranial hemorrhage — Charlie Stolar (clinical) [Ep 8 · 44:11](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2651)
- For non-ECMO babies, repair timing is when they're on minimal ventilator settings (FiO2 0.4, conventional settings), which typically takes 3-4 days — Charlie Stolar (clinical) [Ep 8 · 45:42](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2742)
- Use the infant ventilator instead of anesthesia machine intraoperatively; infant anesthesia machines have high dead space and aren't very compliant — Charlie Stolar (clinical) [Ep 8 · 46:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2767)
- Anesthesia can be all intravenous (muscle relaxants and narcotics); you don't need an anesthesia machine — Charlie Stolar (clinical) [Ep 8 · 46:28](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2788)
- Pre-repair assessment includes pre/post-ductal gradient, echo showing RV not dilated, RV pressure no more than systemic (not super-systemic), acceptable tricuspid regurgitation, and acceptable pulmonary outflow tract acceleration times — Charlie Stolar (clinical) [Ep 8 · 46:47](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2807)
- Perioperative antibiotics (typically ampicillin-gentamicin) are given because a patch may be placed in a newborn — Charlie Stolar (clinical) [Ep 8 · 47:57](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2877)
- The thoracoscopic approach provides a gorgeous view and often the bowel reduces with chest insufflation, but only rock-stable kids are candidates because you're creating a tension pneumothorax in a potentially hypercapnic baby — Charlie Stolar (clinical) [Ep 8 · 48:32](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2912)
- In Dr. Stolar's series of 35 thoracoscopic CDH repairs in stable babies, recurrence rate was about 25% in under a year; APSA outcomes committee meta-analysis reached similar conclusions — Charlie Stolar (clinical) [Ep 8 · 49:37](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2977)
- Laparoscopic CDH repair is problematic because the scaphoid abdomen has loss of abdominal domain; insufflating just puts air up in the chest — Charlie Stolar (opinion) [Ep 8 · 50:21](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3021)
- For open repair, key is adequate subcostal incision (not a small two-finger incision); rotate liver out of chest and abdomen to see the defect — Charlie Stolar (clinical) [Ep 8 · 54:58](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3298)
- Critical repair points are all medial where structures with names are located; mobilize posterior leaflet by unrolling it like a window shade down to the body wall until you feel rib — Charlie Stolar (clinical) [Ep 8 · 55:31](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3331)
- The medial repair is hardest because sometimes the esophagus or aorta hangs out with nothing to sew to; use an upside-down U-shaped pericardial flap rotated down to where the diaphragm would be to begin the repair — Charlie Stolar (clinical) [Ep 8 · 56:11](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3371)
- Favor monofilament suture (like PDS) because it doesn't saw through tissue when pulled, unlike braided suture like Vicryl — Charlie Stolar (opinion) [Ep 8 · 57:16](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3436)
- For patches, favor non-biologic material like 1mm Gore-Tex; laterally, anchor the patch to the ribs by getting a needle around the rib and into the patch — Charlie Stolar (clinical) [Ep 8 · 57:59](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3479)
- Make the patch somewhat balloon-shaped with redundancy so the baby doesn't rip sutures out with a deep breath; over time it gets incorporated into fibrous tissue — Charlie Stolar (clinical) [Ep 8 · 58:43](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3523)
- For thoracoscopic repair, use 3 ports (4mm camera with 30-degree lens, 3mm neonatal instruments), insufflation peak pressure 5-7 cm (no more), and reduce spleen last as it obturates the hole and keeps bowel in the belly — Charlie Stolar (clinical) [Ep 8 · 60:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3623)
- Thoracoscopically, mobilizing the posterior leaflet is difficult because it's rolled into the abdomen and hard to see around the corner — Charlie Stolar (clinical) [Ep 8 · 61:35](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3695)
- For thoracoscopic patch placement, use extracorporeal-intracorporeal suture technique: come from outside through skin around rib into patch and back out, tie externally, and bury the knot under the skin — Charlie Stolar (clinical) [Ep 8 · 62:03](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3723)
- If you can see through the diaphragm (it's just pleura and peritoneum with no muscle), resect it back to something that looks like muscle; plication of see-through tissue will fail — Charlie Stolar (clinical) [Ep 8 · 64:16](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3856)
- The ipsilateral lung is small and not as big as the pleural space; that's how God made this lung. You won't inflate the lung to fill the chest — Charlie Stolar (clinical) [Ep 8 · 66:47](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4007)
- The pleural space will be obliterated either slowly by lung growth over 3-4 years or by filling with fluid; it's not a pneumothorax under pressure, it's pneumothorax ex vacuo — Charlie Stolar (clinical) [Ep 8 · 67:01](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4021)
- Chest tube on water-seal suction will distort the mediastinum and precipitate a pulmonary hypertensive crisis; there's no reason to put in a chest tube unless there's active air leak or bleeding — Charlie Stolar (clinical) [Ep 8 · 67:18](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4038)
- Typical stable post-op CDH baby will be unstable for about a day with increased ventilator requirements, then improve and get extubated in 4-5 days — Charlie Stolar (clinical) [Ep 8 · 68:53](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4133)
- CDH is a field defect affecting the entire foregut from pharynx to ligament of Treitz; these kids have disordered motility throughout — Charlie Stolar (clinical) [Ep 8 · 69:34](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4174)
- All CDH patients should have a GI series showing dilated, ectatic, abnormal esophagus; manometry and impedance show abnormal esophageal and gastric motility and emptying — Charlie Stolar (clinical) [Ep 8 · 69:51](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4191)
- The foregut problem is not really reflux; calling it reflux has suckered surgeons into doing fundoplications and pyloroplasties that are basically torture — Charlie Stolar (opinion) [Ep 8 · 70:09](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4209)
- CDH babies do well with continuous feedings slowly condensed to bolus; surgical intervention for foregut issues is unusual and should be approached as palliation — Charlie Stolar (clinical) [Ep 8 · 70:28](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4228)
- Nissen fundoplication is a poor operation for CDH kids (like for esophageal atresia) because their motility is abnormal; if surgery is needed, use a partial wrap with gastrostomy and real drainage procedure (Jaboulay-Finney type, not Heineke-Mikulicz) — Charlie Stolar (opinion) [Ep 8 · 70:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4240)
- Dr. Stolar's multidisciplinary CDH clinic follows 450-500 patients for life, addressing heart, lung, foregut, nutrition, neurodevelopmental, and axial skeleton issues that emerge over time — Charlie Stolar (clinical) [Ep 8 · 72:11](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4331)
- Dr. Stolar has 4 CDH teenagers with Barrett's esophagitis; he recommends lifelong proton pump inhibitors and regular endoscopic surveillance — Charlie Stolar (clinical) [Ep 8 · 73:18](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4398)
- CDH patients have increased incidence of attention deficit disorders and autism; early intervention for neuropsychiatric issues is recommended — Charlie Stolar (clinical) [Ep 8 · 73:57](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4437)
- As a field defect, CDH causes asymmetric chest growth leading to pectus-like distortion; some patients need Nuss-type operations to rebuild chest wall — Charlie Stolar (clinical) [Ep 8 · 74:09](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4449)
- Some CDH girls have no breast development on the hernia side as teenagers; combined Nuss operation and breast implant procedures have been performed — Charlie Stolar (clinical) [Ep 8 · 74:29](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4469)
- CDH patients develop thoracolumbar scoliosis (not idiopathic scoliosis, as it's mostly in boys); early bracing programs help minimize this — Charlie Stolar (clinical) [Ep 8 · 74:34](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4474)
- CDH recurrence is related to tension on tissues and tissue quality; it's a tough problem whether tissue-to-tissue or prosthetic repair — Charlie Stolar (clinical) [Ep 8 · 75:16](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4516)
- Recurrence is more common with left-sided CDH than right because the liver plugs up the hole on the right — Charlie Stolar (clinical) [Ep 8 · 77:35](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4655)
- For right-sided CDH, the most important consideration is determining where hepatic veins drain; not infrequently they enter directly into the right atrium, not the suprahepatic IVC — Charlie Stolar (clinical) [Ep 8 · 77:51](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4671)
- If hepatic veins enter the right atrium directly, attempting to reduce the liver into the abdomen will cause a troublesome moment; you should not try to put that liver in the abdomen — Charlie Stolar (clinical) [Ep 8 · 78:09](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4689)
- Hepatopulmonary fusion actually exists in right-sided CDH; the liver and lung are fused and cannot be separated surgically — Charlie Stolar (clinical) [Ep 8 · 78:29](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4709)
- Most patients with hepatopulmonary fusion don't survive; they often have associated severe congenital heart disease and IVC interruption with azygous continuation — Charlie Stolar (clinical) [Ep 8 · 79:11](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4751)
- For right-sided CDH, prep the baby for both thoracic and abdominal incisions; often need to be on both sides to figure out what's going on because the liver is in the way — Charlie Stolar (clinical) [Ep 8 · 79:48](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4788)
- For right-sided CDH, can put a scope through an open thoracotomy to see around corners where the liver might come up against the heart — Charlie Stolar (clinical) [Ep 8 · 80:12](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4812)
- Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases — Carlos Colunga (clinical) [Ep 31 · 0:24](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=24)
- Tracheomalacia symptoms typically receded within 55 months in FETO-treated infants — Carlos Colunga (clinical) [Ep 31 · 0:29](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=29)
- FETO-treated infants showed a larger trachea, approximately 31% wider — Carlos Colunga (clinical) [Ep 31 · 0:33](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33)
- 37% of tracheally occluded cases retained metallic balloon components — Carlos Colunga (clinical) [Ep 31 · 0:33](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33)
- No significant complications were reported from retained metallic balloon components — Carlos Colunga (clinical) [Ep 31 · 0:33](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33)
- Tracheal occlusion is effective in promoting lung growth — Carlos Colunga (clinical) [Ep 31 · 0:46](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46)
- FETO is associated with a higher risk of tracheomalacia — Carlos Colunga (clinical) [Ep 31 · 0:46](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46)
- Most cases of FETO-associated tracheomalacia resolve and do not appear to have long-term effects — Carlos Colunga (clinical) [Ep 31 · 0:46](https://team.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46)
- For stable CDH patients not on ECMO, waiting 24-48 hours allows transitional circulation to stabilize and provides ventilator reserve before repair — Ron (clinical) [Ep 1 · 2:49](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=169)
- Bowel distention in unreduced CDH compromises pulmonary and cardiac function over time, favoring earlier repair (clinical) [Ep 1 · 3:40](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=220)
- Echocardiography to assess pulmonary hypertension guides timing of CDH repair — David (clinical) [Ep 1 · 3:53](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=233)
- Recurrence rates improve with surgical experience and technique refinement in thoracoscopic CDH repair — Ron (opinion) [Ep 1 · 6:49](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=409)
- Surgeons may unconsciously avoid placing adequate sutures in MIS repair if knot-tying is time-consuming, contributing to recurrence — Wolfan (opinion) [Ep 1 · 9:49](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=589)
- Cauterizing the edge of the CDH defect promotes inflammation and healing, similar to unfolding the posterior leaflet in open repair — Wolfan (clinical) [Ep 1 · 10:17](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=617)
- Excessive tension during thoracoscopic CDH closure can create an overly flat diaphragm, though Avi Schleger's work suggests post-op bowing may not significantly affect outcomes — Wolfan (clinical) [Ep 1 · 10:49](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=649)
- Liberal use of absorbable mesh as underlay beneath primary repair reduces CDH recurrence — Wolfan (clinical) [Ep 1 · 12:48](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=768)
- MIS approach to CDH repair greatly reduces small bowel obstruction compared to laparotomy — Wolfan (clinical) [Ep 1 · 22:53](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1373)
- In the speaker's series, MIS and open CDH repairs showed similar recurrence rates, with patch use being a major factor — Wolfan (epidemiological) [Ep 1 · 23:24](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1404)
- For CDH with agenesis or near-agenesis (type C or D defects), open repair is preferred due to complexity and proximity to esophagus — Wolfan (clinical) [Ep 1 · 23:53](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1433)
- Severe CDH patients (O-to-E ratios 25% or below) often have small left ventricles causing hemodynamic problems in addition to pulmonary issues — Ron (clinical) [Ep 1 · 25:35](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1535)
- VV ECMO may not work well in CDH patients with small left ventricles; VA ECMO is preferred in those cases — Ron (clinical) [Ep 1 · 26:02](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1562)
- Inhaled nitric oxide (iNO) should not be trialed before ECMO in severe CDH; data show it does not work pre-ECMO — Ron (clinical) [Ep 1 · 26:20](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1580)
- After birth, severe CDH patients may initially have high CO2 that falls over the first couple hours; this response guides ECMO cannulation timing — Ron (clinical) [Ep 1 · 26:51](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1611)
- When repairing CDH on ECMO, leaving the abdomen open or using a silo prevents compromised pulmonary compliance from increased intra-abdominal pressure — Ron (clinical) [Ep 1 · 34:21](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2061)
- Transversalis muscle flap repair for CDH shows very low recurrence rates but results in abdominal wall bulge — Wolfan (clinical) [Ep 1 · 36:41](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2201)
- Overall mortality for any CDH patient requiring ECMO is approximately 50% — Ron (epidemiological) [Ep 1 · 37:34](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2254)
- Midgut volvulus after CDH repair is surprisingly low in incidence; routine Ladd's procedure is not performed — Wolfan (epidemiological) [Ep 1 · 38:33](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2313)
- Indications for the FETO trial (fetal tracheal occlusion) are liver herniation and lung-to-head ratio (LHR) greater than 0.9 — Wolfan (guideline) [Ep 1 · 41:18](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2478)
- 60% of gastric volvulus cases in the pediatric population happen in the first year of life, with about 21% in the first month. — Jason Frischer (epidemiological) [Ep 15 · 1:33](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=93)
- In a 4-month-old child with gastric volvulus, acute presentation is more likely than chronic. — Jason Frischer (clinical) [Ep 15 · 1:58](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=118)
- Key presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube. — Beth Rymeski (clinical) [Ep 15 · 2:38](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=158)
- A little bit of bloody aspirate from the NG tube and a funny looking stomach bubble on X-ray are key findings in gastric volvulus. — Jason Frischer (clinical) [Ep 15 · 2:47](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=167)
- Chronic gastric volvulus is more related to laxity of the gastric ligaments including gastrophrenic, gastrosplenic, gastrocolic, and gastrohepatic ligaments. — Jason Frischer (clinical) [Ep 15 · 3:10](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=190)
- Organoaxial volvulus is the first and most common type of gastric volvulus. — Jason Frischer (clinical) [Ep 15 · 3:43](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=223)
- In organoaxial volvulus, the stomach spins around an axis drawn between the GE junction and the pylorus, with the greater curvature flipping up and over to become more superior than the lesser curvature. — Jason Frischer (clinical) [Ep 15 · 3:55](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=235)
- In mesenteroaxial volvulus, rotation occurs around a line through the middle of the stomach from lesser to greater curvature, with the stomach flipping behind and back over. — Jason Frischer (clinical) [Ep 15 · 4:18](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=258)
- In gastric volvulus, when filled with contrast, the pylorus appears right next to or near the GE junction and above the body of the stomach. — Jason Frischer (clinical) [Ep 15 · 4:46](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=286)
- In mesenteroaxial volvulus, the duodenum may fill above or superior to the GE junction because the pylorus has flipped up and over or behind and over the top of the stomach. — Jason Frischer (clinical) [Ep 15 · 6:08](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=368)
- Surgical management of gastric volvulus should be attempted laparoscopically, with the first step being to bring the stomach down from the chest if herniated. — Carolina Pinzon Guzman (clinical) [Ep 15 · 7:09](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=429)
- G-tube placement is used to pexy the stomach to the abdominal wall to prevent recurrent twisting in gastric volvulus. — Carolina Pinzon Guzman (clinical) [Ep 15 · 7:26](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=446)
- When managing gastric volvulus found during CDH repair, viability of the stomach must always be checked, especially if chronically volvulized or volvulized for a couple of days, by looking at the serosa and blood flow. — Jason Frischer (clinical) [Ep 15 · 8:40](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=520)
- In acute gastric volvulus with sudden onset of symptoms, initial management includes securing two good points of IV access and managing the ABCs before proceeding to imaging or surgery. — Chris Pastor (clinical) [Ep 15 · 9:38](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=578)
- In an acutely ill infant with suspected gastric volvulus, an urgent upper GI should be obtained while resuscitating, as malrotation is more common and must be differentiated from gastric volvulus. — Chris Pastor (clinical) [Ep 15 · 10:08](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=608)
- CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies managed by community obstetricians. — Charlie Stolar (epidemiological) [Ep 3 · 2:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=165)
- CDH diagnosis is usually made at the 20-week anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart. — Charlie Stolar (clinical) [Ep 3 · 3:37](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=217)
- CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side. — Charlie Stolar (clinical) [Ep 3 · 4:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=254)
- At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation. — Charlie Stolar (clinical) [Ep 3 · 4:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=263)
- CDH is a medical physiologic emergency, not a surgical emergency. — Charlie Stolar (clinical) [Ep 3 · 5:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=300)
- The diagnosis of CDH alone is not an indication for cesarean section. — Charlie Stolar (guideline) [Ep 3 · 5:24](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=324)
- Antenatal interventions for CDH are no better than investigational and experimental at best. — Charlie Stolar (opinion) [Ep 3 · 6:35](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=395)
- Babies with CDH should be born at a full-service children's facility with ECMO capability. — Charlie Stolar (guideline) [Ep 3 · 7:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=443)
- Maybe 10-15% of babies diagnosed with CDH will benefit from ECMO. — Charlie Stolar (epidemiological) [Ep 3 · 7:34](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=454)
- In single-center experiences, presence of liver in the chest is of no prognostic value for CDH. — Charlie Stolar (clinical) [Ep 3 · 8:31](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=511)
- Lung-to-head ratio (LHR) is of limited prognostic value except when very low (less than 0.8). — Charlie Stolar (clinical) [Ep 3 · 8:42](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=522)
- Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis in CDH. — Charlie Stolar (clinical) [Ep 3 · 9:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=547)
- If shown 100 children with CDH, 80-85% will survive to become teenagers. — Charlie Stolar (epidemiological) [Ep 3 · 10:13](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=613)
- Steroids have tremendous value for preterm labor under 35 weeks but their role in near-term CDH babies (37-39 weeks) is arguable. — Charlie Stolar (clinical) [Ep 3 · 10:37](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=637)
- Exit-to-ECMO for CDH is essentially moving the goalposts and deck chairs around on the Titanic for non-viable babies. — Charlie Stolar (opinion) [Ep 3 · 12:06](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=726)
- We are born with about 1/2 to 2/3 of our full complement of alveoli and can grow the balance sometime after birth. — Charlie Stolar (clinical) [Ep 3 · 13:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=780)
- All therapy for CDH should be guided by preductal oximetry, not postductal, because all babies have some degree of pulmonary hypertension with shunting. — Charlie Stolar (guideline) [Ep 3 · 19:06](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1146)
- If preductal saturation is 90% (PaO2 of 65 torr), the brain is doing fine because this is fetal hemoglobin. — Charlie Stolar (clinical) [Ep 3 · 19:32](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1172)
- Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today because they trash lungs in a heartbeat. — Charlie Stolar (opinion) [Ep 3 · 21:38](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1298)
- CDH babies should not be paralyzed and should have minimal sedation to maintain spontaneous breathing. — Charlie Stolar (guideline) [Ep 3 · 21:56](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1316)
- Most CDH babies don't tolerate conventional ventilator settings (rate 40, peak pressure 25-28, PEEP 5) and require unconventional high-rate (100 breaths/min) low-pressure ventilation. — Charlie Stolar (clinical) [Ep 3 · 22:15](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1335)
- High-frequency oscillatory ventilation (HFOV) as rescue therapy rarely spares CDH babies from ECMO. — Charlie Stolar (clinical) [Ep 3 · 24:38](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1478)
- Nitric oxide is a waste of money for CDH babies; meta-analyses show it's terrific for premature babies with immature lung disease but of no value in CDH. — Charlie Stolar (clinical) [Ep 3 · 25:45](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1545)
- The best drug for CDH is oxygen. — Charlie Stolar (opinion) [Ep 3 · 26:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1567)
- ECMO should not be used in babies under 36 weeks gestational age initially, though this has been pushed down to 35 weeks, maybe 34 weeks, with intracranial hemorrhage rates taking off below 32 weeks. — Charlie Stolar (guideline) [Ep 3 · 26:22](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1582)
- The smallest ECMO arterial perfusion cannula available is about 8 French, and resistance is related to both length and diameter, making adequate flow difficult in very small babies. — Charlie Stolar (clinical) [Ep 3 · 27:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1660)
- For ECMO candidacy, the real risk for intracranial hemorrhage is the germinal matrix, which is usually OK by 35-36 weeks gestation, so it's gestational age that matters, not size. — Charlie Stolar (clinical) [Ep 3 · 28:15](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1695)
- The broad principle for ECMO candidacy is whether you can get out of ECMO with reasonable confidence if you get in—don't start something you can't finish. — Charlie Stolar (guideline) [Ep 3 · 29:10](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1750)
- VV ECMO is terrific if the heart works, but in CDH the heart function is often depressed and it's hard to get the cannula in with the shifted mediastinum. — Charlie Stolar (clinical) [Ep 3 · 30:27](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1827)
- VA bypass is essentially dialing in a PaO2, while VV ECMO is much more annoying with mixing, cannula position issues, and CDH babies are generally too unstable for VV. — Charlie Stolar (opinion) [Ep 3 · 31:53](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1913)
- Echo guidance during ECMO cannulation is really helpful to prevent driving the arterial cannula out the subclavian artery or the venous cannula into the innominate vein. — Charlie Stolar (clinical) [Ep 3 · 32:17](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1937)
- If the arterial cannula goes out the subclavian artery, you'll have a very well-perfused hand and think preductal sats look good, but the baby isn't seeing the oxygen. — Charlie Stolar (clinical) [Ep 3 · 33:01](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1981)
- The first few hours on ECMO can be unstable; hyperkalemia cardiac arrest can occur if blood isn't washed, but you just perfuse through it and give calcium. — Charlie Stolar (clinical) [Ep 3 · 34:19](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2059)
- ECMO flow should be slowly increased over 45 minutes to 1.5 hours to about 100-125 cc/kg/min (about 80% of cardiac output) to reduce intracranial hemorrhage incidence. — Charlie Stolar (guideline) [Ep 3 · 34:55](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2095)
- The hyperoxia test—turning FIO2 up to 1.0 on the ventilator while on ECMO—gives courage to begin weaning if the PaO2 rises, showing the baby can use their lungs. — Charlie Stolar (clinical) [Ep 3 · 36:34](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2194)
- For babies stuck on ECMO at 2 weeks, ensure they are maximally dried out (bone dry, eyes sucked into back of head, turned into a prune) before considering on-ECMO repair. — Charlie Stolar (guideline) [Ep 3 · 38:18](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2298)
- The problem in CDH is not that bowel is in the chest; the problem is growth arrest of the lungs that happened at 14-15 weeks gestation. Getting bowel out of the chest is not miraculous. — Charlie Stolar (clinical) [Ep 3 · 39:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2354)
- Heparin inhibits conversion of fibrinogen to fibrin, so only platelets (beat-up ones) make clot on ECMO. A platelet thrombus lasts 48-72 hours, giving a window to operate and get off ECMO before bleeding starts. — Charlie Stolar (clinical) [Ep 3 · 40:37](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2437)
- Preferred approach is to wean ECMO down to 20 cc/kg/min, do the operation, accept 1 day of post-op edema, then have 2-3 days to get off ECMO before bleeding starts. — Charlie Stolar (guideline) [Ep 3 · 41:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2474)
- If you take a baby off ECMO then operate, every patient gets stiff after surgery, pulmonary hypertension relapses, and you're talking about a second ECMO run. — Charlie Stolar (clinical) [Ep 3 · 41:51](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2511)
- When operating on ECMO, load with Amicar preoperatively, do it as an abdominal operation, use a patch with low threshold to avoid tension, place a Jackson-Pratt drain under the patch, and place a chest tube. — Charlie Stolar (guideline) [Ep 3 · 42:39](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2559)
- Futility on ECMO starts to rear its head after about 2-3 weeks. — Charlie Stolar (opinion) [Ep 3 · 44:14](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2654)
- The typical stable CDH baby not requiring ECMO takes 3-4 days to wean to minimal ventilator settings (FIO2 0.4, conventional settings) before repair. — Charlie Stolar (clinical) [Ep 3 · 45:42](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2742)
- Use the infant ventilator instead of an anesthesia machine intraoperatively because infant anesthesia machines have high dead space and are not very compliant. — Charlie Stolar (guideline) [Ep 3 · 46:07](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2767)
- For repair timing, three variables matter: pre/post-ductal gradient on pulse ox, right ventricle dilation on echo, and RV pressure versus LV pressure (RV should be no more than systemic). — Charlie Stolar (guideline) [Ep 3 · 46:47](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2807)
- The thoracoscopic approach for CDH is gorgeous with a sparkling view, but the recurrence rate is really high—about 25% in under a year in Dr. Stolar's series of 35 stable kids. — Charlie Stolar (clinical) [Ep 3 · 48:32](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2912)
- The APSA outcomes committee meta-analysis came to a very similar conclusion about high thoracoscopic CDH recurrence rates. — Charlie Stolar (clinical) [Ep 3 · 50:02](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3002)
- For open CDH repair, need a real subcostal incision (not a small two-finger incision), rotate the liver out of chest and abdomen, eviscerate bowel, and mobilize the posterior leaflet like unrolling a window shade down to rib. — Charlie Stolar (guideline) [Ep 3 · 55:02](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3302)
- The medial part of CDH repair is hardest because sometimes the esophagus or aorta is hanging out with nothing to sew to. — Charlie Stolar (clinical) [Ep 3 · 56:06](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3366)
- When there's no diaphragm to sew to medially, make an upside-down U-shaped incision on the pericardium and rotate that down to where the diaphragm would be to begin the repair. — Charlie Stolar (guideline) [Ep 3 · 56:28](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3388)
- Favor monofilament suture (like PDS) because it doesn't saw through tissue when pulled, unlike Vicryl which saws tissue. — Charlie Stolar (opinion) [Ep 3 · 57:16](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3436)
- Favor non-biologic material like 1mm Gore-Tex for patches, and anchor the patch to the ribs laterally by getting a needle around the rib. — Charlie Stolar (guideline) [Ep 3 · 57:59](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3479)
- Make the patch somewhat balloon-shaped with redundancy so the baby doesn't rip sutures out taking a deep breath; over time it gets incorporated into fibrous tissue. — Charlie Stolar (guideline) [Ep 3 · 58:43](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3523)
- For thoracoscopic CDH repair, use 3 ports (4mm camera with 30-degree lens, 3mm neonatal instruments), insufflation peak pressure 5-7 cm (no more), and put solid organs (spleen or left liver lobe) in last to plug the hole and keep bowel down. — Charlie Stolar (guideline) [Ep 3 · 60:23](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3623)
- There is no indication for a chest tube in CDH except for active air leak or anticipated/active bleeding. The ipsilateral lung is small and won't fill the pleural space—that's how God made this lung. — Charlie Stolar (guideline) [Ep 3 · 66:47](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4007)
- A pneumothorax in CDH is a pneumothorax ex vacuo, not air under pressure. Putting in a chest tube on water seal suction will just distort the mediastinum and precipitate a pulmonary hypertensive crisis. — Charlie Stolar (clinical) [Ep 3 · 67:13](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4033)
- The typical stable CDH baby will be crummy for about a day postoperatively, then get better and be extubated in 4-5 days and go home. — Charlie Stolar (clinical) [Ep 3 · 68:54](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4134)
- CDH is a field defect affecting the whole foregut from pharynx to ligament of Treitz. Everything—esophagus, stomach, gastric emptying—has abnormal motility. — Charlie Stolar (clinical) [Ep 3 · 69:39](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4179)
- If you do a GI series on CDH kids, the esophagus will be very dilated, ectatic, and abnormal-looking. Manometry and impedance manometry are abnormal. — Charlie Stolar (clinical) [Ep 3 · 69:51](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4191)
- It's not really reflux in CDH—calling it reflux has suckered surgeons into doing fundoplications and pyloroplasties that are basically torture. — Charlie Stolar (opinion) [Ep 3 · 70:09](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4209)
- CDH kids generally do well with continuous feedings slowly condensed to bolus. It's unusual to need surgical intervention for foregut dysmotility. — Charlie Stolar (clinical) [Ep 3 · 70:28](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4228)
- When surgery is needed for CDH foregut dysmotility, approach it as palliation: some sort of fundoplication (not Nissen—it's fully competent on an abnormal-motility esophagus), combined with gastrostomy and a real drainage procedure like Jaboulay-Finney, not Heineke-Mikulicz. — Charlie Stolar (guideline) [Ep 3 · 70:36](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4236)
- Dr. Stolar has 4 CDH teenagers with Barrett's esophagitis and now recommends lifelong proton pump inhibitors and regular scoping for all CDH patients. — Charlie Stolar (clinical) [Ep 3 · 73:18](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4398)
- Dr. Stolar's 1989-1990 paper showed most CDH kids turn out OK unless the mother had an 8th grade education and the child is a boy. — Charlie Stolar (clinical) [Ep 3 · 73:46](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4426)
- There is an incidence of attention deficit disorders and autism in CDH survivors, prompting early intervention for neuropsychiatric issues. — Charlie Stolar (clinical) [Ep 3 · 73:58](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4438)
- Because CDH is a field defect, there's asymmetric chest growth leading to pectus-like distorted chest wall growth requiring Nuss-type operations in some patients. — Charlie Stolar (clinical) [Ep 3 · 74:09](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4449)
- Some CDH girls as teenagers have no breast development on the side of the hernia, requiring Nuss operation and breast implant. — Charlie Stolar (clinical) [Ep 3 · 74:20](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4460)
- CDH patients can develop non-idiopathic scoliosis (mostly in boys, not the typical idiopathic scoliosis in girls), requiring early bracing to minimize thoracolumbar scoliosis. — Charlie Stolar (clinical) [Ep 3 · 74:34](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4474)
- If you can see through the diaphragm tissue (it's nothing but pleura and peritoneum), resect it back to muscle for a fresh edge to sew together, or the plication will fail. — Charlie Stolar (guideline) [Ep 3 · 64:16](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3856)
- For right-sided CDH, the most important consideration is to ask echocardiographers where the hepatic veins drain, because they often enter directly into the right atrium, not the suprahepatic cava. — Charlie Stolar (guideline) [Ep 3 · 77:51](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4671)
- Hepatopulmonary fusion actually exists in right-sided CDH. The liver and lung are fused and cannot be separated surgically. Most of these patients don't survive and often have severe congenital heart disease and IVC discontinuation. — Charlie Stolar (clinical) [Ep 3 · 78:36](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4716)
- For right-sided CDH, prep the baby for both thoracic and abdominal incisions because you often need to be on both sides. Start in the abdomen, but if the liver is in the way, make a counter-incision in the chest. — Charlie Stolar (guideline) [Ep 3 · 79:48](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4788)
- Even with an open thoracotomy, you can put a scope in to see around a corner without ugly retractors. — Charlie Stolar (guideline) [Ep 3 · 80:12](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4812)
- Congenital diaphragmatic hernia occurs in 10-20% of monochorionic twin pregnancies and is responsible for large amounts of perinatal mortality and morbidity, with 80-100% mortality if untreated in the past. — Jan Deprest (epidemiological) [Ep 7 · 0:45](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=45)
- Patient selection for FETO is based on lung-to-head ratio (LHR) corrected for gestational age (observed/expected) and presence of liver herniation, with severe hypoplasia defined as maximum 20% survival, moderate 50%, and mild 85% survival. — Jan Deprest (clinical) [Ep 7 · 1:20](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=80)
- The FETO procedure is done at 26-28 weeks (now 29 weeks in updated protocol) under local anesthesia with fetal analgesia and immobilization, lasting 6-10 minutes on average when fetal position is favorable. — Jan Deprest (clinical) [Ep 7 · 3:19](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=199)
- The median gestational age at birth after FETO was 35 weeks, similar to open fetal surgery, with 20-22% experiencing ruptured membranes by 34 weeks. — Jan Deprest (clinical) [Ep 7 · 8:32](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=512)
- Balloon removal in utero at least 24 hours prior to birth is associated with better survival and early morbidity compared to removal at delivery. — Jan Deprest (clinical) [Ep 7 · 11:19](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=679)
- FETO increased survival from around 0% to 20% in the smallest lung group and by 30-35% on average in the severe hypoplasia group compared to historical controls. — Jan Deprest (clinical) [Ep 7 · 12:42](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=762)
- Independent predictors of survival after FETO are initial lung size prior to operation, gestational age at delivery, and ability to remove balloon in utero at least 24 hours before birth. — Jan Deprest (clinical) [Ep 7 · 13:44](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=824)
- Even with delivery prior to 32 weeks after FETO, survival rate is as high as predicted at term without fetal therapy; for delivery at 32 weeks or later, survival is 60%, which doesn't increase beyond 34 weeks. — Jan Deprest (clinical) [Ep 7 · 14:37](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=877)
- There is an apparent decrease in bronchopulmonary dysplasia after FETO, with no evidence of substituting mortality by morbidity based on oxygen need, ventilator days, time to full enteral feeding, and NICU days. — Jan Deprest (clinical) [Ep 7 · 15:50](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=950)
- The TOTAL trial in Europe compares tracheal occlusion at 27-29 weeks to expectant management, with survival as primary outcome in severe cases and survival without BPD in moderate cases. — Jan Deprest (clinical) [Ep 7 · 16:41](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1001)
- Centers offering FETO must have an active fetoscopy program (minimum 36 interventions per year or 3 per month), experience with 15 balloon occlusion cases (at least 5 done locally), and 24-hour balloon removal capability. — Jan Deprest (guideline) [Ep 7 · 19:45](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1185)
- In the moderate TTTS trial, 54 cases have been recruited beyond the first interim analysis, with all participating centers agreeing not to offer fetal therapy outside the trial. — Jan Deprest (clinical) [Ep 7 · 25:05](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1505)
- The severe FETO trial has been hampered by too long offering the procedure outside trial settings while trying to optimize technique, though the last 100 cases showed no improvement in outcomes. — Jan Deprest (opinion) [Ep 7 · 25:44](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1544)
- Ruben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient. — Todd Ponsky (clinical) [Ep 7 · 86:57](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5217)
- Only 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve. — Todd Ponsky (epidemiological) [Ep 7 · 89:21](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5361)
- The recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues. — Todd Ponsky (clinical) [Ep 7 · 92:14](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5534)
- CHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal. — Todd Ponsky (clinical) [Ep 7 · 105:01](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6301)
- CHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature. — Todd Ponsky (clinical) [Ep 7 · 110:00](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6600)
- Diode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP. — Todd Ponsky (clinical) [Ep 7 · 107:05](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6425)
- CHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion. — Todd Ponsky (clinical) [Ep 7 · 141:19](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8479)
- In Type 3 sIUGR, after laser photocoagulation to separate circulations, the smaller twin dies in 75% of cases within 48 hours because it was surviving on blood from the normal twin. — Eduardo Gratacos (clinical) [Ep 7 · 146:21](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8781)
- The CDH study group does not prescribe standardized management protocols; they allow institutions to report cardiac dysfunction as yes/no and specify whether it is systolic or diastolic. — Vic (clinical) [Ep 9 · 7:01](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=421)
- Pulmonary hypertension is a predictor of mortality for CDH infants. — Vic (clinical) [Ep 9 · 7:30](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=450)
- In CDH with pulmonary hypertension, you can see decreased right ventricular ejection, which can lead to bowing of the septum into the left ventricle, resulting in decreased ventricular volumes and decreased ejection. — Vic (clinical) [Ep 9 · 7:35](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=455)
- Cryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results. — Todd Ponsky (opinion) [Ep 9 · 14:53](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=893)
- Protocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study. — Todd Ponsky (opinion) [Ep 9 · 15:06](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=906)
- It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH. — Fung Lim (clinical) [Ep 10 · 1:29](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=89)
- In mild diaphragmatic hernia, the left lung starts to shrink in size. — Fung Lim (clinical) [Ep 10 · 2:05](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=125)
- In moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards. — Fung Lim (clinical) [Ep 10 · 2:11](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=131)
- In the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking. — Fung Lim (clinical) [Ep 10 · 2:24](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=144)
- The tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days. — Fung Lim (guideline) [Ep 10 · 2:44](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=164)
- Anesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother. — Fung Lim (clinical) [Ep 10 · 2:53](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=173)
- An introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space. — Fung Lim (clinical) [Ep 10 · 3:04](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=184)
- The fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located. — Fung Lim (clinical) [Ep 10 · 3:16](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=196)
- The ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi. — Fung Lim (clinical) [Ep 10 · 3:27](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=207)
- A balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place. — Fung Lim (clinical) [Ep 10 · 3:38](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=218)
- The balloon is left in place for a few weeks to accelerate lung growth. — Fung Lim (clinical) [Ep 10 · 4:12](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=252)
- If the baby is in proper position, the balloon can be punctured under ultrasound guidance. — Fung Lim (clinical) [Ep 10 · 4:26](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=266)
- The deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health. — Fung Lim (clinical) [Ep 10 · 4:33](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=273)
- If the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper. — Fung Lim (clinical) [Ep 10 · 4:40](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=280)
- After balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy. — Fung Lim (guideline) [Ep 10 · 4:56](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=296)
- Ideally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons. — Fung Lim (guideline) [Ep 10 · 5:02](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=302)
- Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT. (clinical) [Ep 34 · 1:25](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85)
- With autofluorescence, parathyroids naturally autofluoresce at a specific wavelength without injecting anything. (clinical) [Ep 34 · 9:53](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593)
- Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it. (epidemiological) [Ep 34 · 10:07](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607)
- A surgery-first pathway for pediatric biliary stones reduces resource utilization, including MRCP, according to recently published work. (epidemiological) [Ep 34 · 11:32](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=692)
- With ERCP, you're going to get pancreatitis 10% of the time no matter how good you are. (epidemiological) [Ep 34 · 12:02](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722)
- If you just did flushing or got the catheter a little more into the common bile duct or reamed the sphincter, the success rate was in the 90s. (epidemiological) [Ep 34 · 12:25](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745)
- FETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus. — Beth Rymeski (clinical) [Ep 40 · 0:33](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=33)
- A standard fetoscope with a side channel is used, and the balloon is worked through the side channel. — Beth Rymeski (clinical) [Ep 40 · 0:36](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=36)
- The tongue is an easy landmark to identify during FETO because it is bumpy in appearance. — Beth Rymeski (clinical) [Ep 40 · 1:21](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=81)
- Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement. — Beth Rymeski (clinical) [Ep 40 · 1:29](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=89)
- If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth. — Beth Rymeski (clinical) [Ep 40 · 1:38](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=98)
- The epiglottis is a key landmark to locate when navigating to the trachea. — Beth Rymeski (clinical) [Ep 40 · 1:58](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=118)
- Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage. — Beth Rymeski (clinical) [Ep 40 · 2:23](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=143)
- The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus. — Beth Rymeski (clinical) [Ep 40 · 2:36](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=156)
- The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea. — Beth Rymeski (clinical) [Ep 40 · 2:56](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=176)
- The scope is backed up as the balloon is inflated so that balloon inflation can be watched. — Beth Rymeski (clinical) [Ep 40 · 3:03](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=183)
- The balloon contains a little metal ball that can be visualized. — Beth Rymeski (clinical) [Ep 40 · 3:29](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=209)
- FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus. — Beth Rymeski (clinical) [Ep 41 · 0:33](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=33)
- A standard fetoscope with a side channel is used, and the balloon is worked through the side channel. — Beth Rymeski (clinical) [Ep 41 · 0:36](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=36)
- The tongue is an easy landmark to identify during FETO because it is bumpy in appearance. — Beth Rymeski (clinical) [Ep 41 · 1:21](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=81)
- Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement. — Beth Rymeski (clinical) [Ep 41 · 1:29](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=89)
- If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth. — Beth Rymeski (clinical) [Ep 41 · 1:38](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=98)
- The epiglottis is a key landmark to identify when navigating toward the trachea. — Beth Rymeski (clinical) [Ep 41 · 1:58](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=118)
- Excessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage. — Beth Rymeski (clinical) [Ep 41 · 2:23](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=143)
- The scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea. — Beth Rymeski (clinical) [Ep 41 · 2:36](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=156)
- The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea. — Beth Rymeski (clinical) [Ep 41 · 2:56](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=176)
- The scope is backed up as the balloon is inflated so that balloon inflation can be watched. — Beth Rymeski (clinical) [Ep 41 · 3:03](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=183)
- Indication for minimally invasive CDH repair is any patient stable enough to transport to OR, with pulmonary pressures lower than systemic. (guideline) [Ep 2 · 0:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=0)
- Contraindications to MIS CDH repair include repair on ECMO; liver-up, stomach-up, oscillator use, and redo repair are NOT contraindications. (guideline) [Ep 2 · 1:30](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=90)
- A laparotomy for CDH repair carries significant lifelong risk of small bowel obstruction, which may be underestimated and is a major advantage of MIS approach. (opinion) [Ep 2 · 3:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=180)
- Technical pearls for MIS CDH repair include pericostal sutures, mesh reinforcement, and avoiding tension; agenesis or near-agenesis should prompt conversion to open. (clinical) [Ep 2 · 3:30](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=210)
- All CDH patients have obligate pneumothorax post-repair due to pulmonary hypoplasia; chest tube use is debated. (clinical) [Ep 2 · 7:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=420)
- Biologic mesh alone to bridge a CDH defect is associated with higher recurrence rates; biologics dissolve in the middle due to lack of tissue ingrowth on the chest side. (clinical) [Ep 2 · 10:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=600)
- PTFE-biologic sandwich technique (PTFE on lung side, biologic on abdominal side) reduces recurrence compared to biologic alone, particularly for dome recurrences. (clinical) [Ep 2 · 10:40](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=640)
- Pericostal 'seesaw' suture technique involves bringing suture through small stab incision, around rib, and tying externally; scars fade over time. (clinical) [Ep 2 · 8:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=480)
- Biologic underlay should extend beyond the primary repair edge by 1-2 cm, with sutures taking bites of diaphragm and mesh away from the edge to create overlap. (clinical) [Ep 2 · 12:39](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=759)
- In multivariate analysis of institutional experience, use of biologic mesh alone was a major risk factor for CDH recurrence. (epidemiological) [Ep 2 · 12:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=720)
- Institutional comfort and experience with VV ECMO management affects outcomes; some centers routinely convert VV to VA due to instability. (clinical) [Ep 2 · 27:02](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1622)
- VV ECMO cannulation technique uses open cut-down with cephalad cannula to smooth out first 24 hours and improve flows. (clinical) [Ep 2 · 29:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1740)
- Some institutions repair very sick CDH patients early in ECMO run (first 24-48 hours) with reported decreased bleeding risk, though this is debated. — Jason (clinical) [Ep 2 · 37:16](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2236)
- Patients who linger then have acute hypertensive crisis and go on ECMO may be repaired off ECMO after short run; long-riders may be repaired early if stable. — Jason (clinical) [Ep 2 · 37:16](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2236)
- Transversus abdominis flap technique involves transverse abdominal incision at umbilicus level, developing transversus plane, maintaining blood supply; half the flap remains naturally attached to lateral wall. (clinical) [Ep 2 · 43:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2580)
- Muscle flap reconstruction carries risk of abdominal wall deformity; patient selection is important. (clinical) [Ep 2 · 43:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2580)
- In recurrent-recurrent CDH, latissimus flaps or large chest wall muscle flaps may be used as salvage. (clinical) [Ep 2 · 42:20](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2540)
- Sewing to good tissue is critical; recurrences may occur when suturing to scar tissue rather than viable diaphragm. (clinical) [Ep 2 · 42:20](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2540)
- Days to repair are less important than change in pulmonary pressure over time; goal is to avoid repairing during physiologic instability. (clinical) [Ep 2 · 17:45](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1065)
- Historical 'honeymoon period' where stable CDH neonates suddenly crash to ECMO is seen less often now but remains a concern. (clinical) [Ep 2 · 18:10](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1090)
- Physiologic defect in CDH is pulmonary, not the intestines in the chest ('not the chits in the chest'). (clinical) [Ep 2 · 19:10](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1150)
- Decision to place CDH patient on ECMO is joint between pediatric surgeon and neonatologist; institutional variability exists. (clinical) [Ep 2 · 22:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1320)
- Institutional practice: if CDH patient cannot be weaned from ECMO, transition to comfort measures rather than last-ditch repair on ECMO. (clinical) [Ep 2 · 35:20](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2120)
- Hypoplastic lungs of babies with pulmonary hypoplasia secondary to CDH have impaired fetal lung growth and maturation — Kasra Khalaj (clinical) [Ep 13 · 0:31](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=31)
- Several treatment agents have been administered prenatally for CDH, but none have been shown to fully rescue lung development — Kasra Khalaj (clinical) [Ep 13 · 0:39](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=39)
- Extracellular vesicles are nanoparticles known to be the mediators of stem cell paracrine signaling — Kasra Khalaj (clinical) [Ep 13 · 0:45](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=45)
- AFSCEV administration rescued the number of lung branches back to normal in CDH models — Kasra Khalaj (clinical) [Ep 13 · 0:56](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=56)
- AFSCEVs improve fetal lung maturation as shown by rescuing the expression of surfactant protein C — Kasra Khalaj (clinical) [Ep 13 · 1:07](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=67)
- AFSCEVs contain microRNA 17-92 cluster, which has been reported in the literature to modulate fetal lung development — Kasra Khalaj (clinical) [Ep 13 · 1:17](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=77)
- Knockout of the microRNA 17-92 cluster can recapitulate pulmonary hypoplasia — Kasra Khalaj (clinical) [Ep 13 · 1:31](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=91)
- Autophagy has been shown to be critical for lung branching morphogenesis — Kasra Khalaj (clinical) [Ep 13 · 1:46](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=106)
- Autophagy is a recycling mechanism of cellular trash and is one of the key ways that cell survival is promoted — Kasra Khalaj (clinical) [Ep 13 · 1:55](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=115)
- Autophagy is most impaired at the pseudoglandular and canalicular stages in the nitrofen model of CDH — Kasra Khalaj (clinical) [Ep 13 · 2:04](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=124)
- CDH fetal lungs show reduced levels of Beclin 1 and ATG5 (autophagy activators) and higher levels of sequestosome (autophagy adapter) at pseudoglandular and canalicular stages — Kasra Khalaj (clinical) [Ep 13 · 2:18](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=138)
- High levels of sequestosome indicate autophagy impairment — Kasra Khalaj (clinical) [Ep 13 · 2:18](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=138)
- Treatment with AFSCEVs restores autophagy key genes (Beclin 1, ATG5, sequestosome) at the pseudoglandular and canalicular stage — Kasra Khalaj (clinical) [Ep 13 · 2:32](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=152)
- AFSCEVs are taken up by virtually all cells in fetal lung explants, including the fetal lung epithelium — Kasra Khalaj (clinical) [Ep 13 · 2:56](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=176)
- Activation of autophagy by AFSCEVs is localized in the lung epithelial compartment of the fetal lung microenvironment — Kasra Khalaj (clinical) [Ep 13 · 3:19](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=199)
- Knockdown of microRNAs 17 and 20 in AFSCEVs results in increased sequestosome and down regulation of Beclin mRNA, indicating impaired autophagy — Kasra Khalaj (clinical) [Ep 13 · 3:27](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=207)
- Knockdown of microRNAs 17 and 20 results in lower levels of LC3B2 protein, which is the active isoform of the autophagy cascade — Kasra Khalaj (clinical) [Ep 13 · 3:53](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=233)
- Human fetal lung explant model of pulmonary hypoplasia was established using fetal lungs from healthy terminated fetuses from 15 to 19 weeks of gestation, corresponding to late pseudoglandular and canalicular stages — Kasra Khalaj (clinical) [Ep 13 · 4:10](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=250)
- In human hypoplastic fetal lung explants, there is a reduction of Beclin 1 and ATG5 at the mRNA level — Kasra Khalaj (clinical) [Ep 13 · 4:37](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=277)
- Treatment with human AFSCEVs results in restoration of Beclin 1 and ATG5 in human hypoplastic fetal lung explants — Kasra Khalaj (clinical) [Ep 13 · 4:58](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=298)
- At the protein level in human tissue, all three autophagy markers (Beclin 1, ATG5, sequestosome) were dysregulated in the hypoplastic group, and human AFSCEVs restored all three markers back to control — Kasra Khalaj (clinical) [Ep 13 · 5:04](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=304)
- This is the first study discovering autophagy impairment as an important mechanism in CDH pathophysiology — Kasra Khalaj (opinion) [Ep 13 · 5:17](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=317)
- Autophagy levels are restored with administration of AFSCEVs, thus partially explaining their effect on branching morphogenesis — Kasra Khalaj (clinical) [Ep 13 · 5:24](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=324)
- Autophagy can be targeted with microRNAs 17 and 20 — Kasra Khalaj (clinical) [Ep 13 · 5:31](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=331)
- Future work includes looking at ER stress, which is very closely interrelated with autophagy pathway, to see if AFSCEVs can exert an effect on this related mechanism — Kasra Khalaj (opinion) [Ep 13 · 7:39](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=459)
- Studies in oncology have shown that the quantity of extracellular vesicles released when autophagy is impaired is different — Kasra Khalaj (clinical) [Ep 13 · 8:07](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=487)
- Future functional studies will examine endogenous extracellular vesicle production in hypoplastic fetal lungs — Kasra Khalaj (opinion) [Ep 13 · 8:37](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=517)
- Initial protocol focus was on delivery room, ECMO utilization, and ventilator management, then progressed system by system through GI, cardiac, and neuro — Paul Kingma (clinical) [Ep 39 · 0:27](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=27)
- Previously, for non-ECMO patients, surgical repair was performed when echocardiography demonstrated improved pulmonary hypertension, ranging from a few days to as late as 56 days — Paul Kingma (clinical) [Ep 39 · 0:46](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=46)
- Under the new protocol, all ECMO patients are repaired within the first 12 to 24 hours of ECMO cannulation — Paul Kingma (clinical) [Ep 39 · 1:09](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=69)
- All non-ECMO patients are repaired between day 4 and 8, provided they are stable, which applies to the vast majority — Paul Kingma (clinical) [Ep 39 · 1:16](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=76)
- The new protocol never exceeds a peak pressure of 22 cmH2O — Paul Kingma (clinical) [Ep 39 · 1:39](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=99)
- A standardized escalation and weaning protocol is followed approximately 100% of the time — Paul Kingma (clinical) [Ep 39 · 1:42](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=102)
- The clinical philosophy is that if you protect the lungs, all the rest will fall in line and improve — Paul Kingma (opinion) [Ep 39 · 1:35](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=95)
- Every baby now gets started on hydrocortisone for blood pressure support — Paul Kingma (clinical) [Ep 39 · 1:51](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=111)
- There is a standardized protocol for which pressors are used — Paul Kingma (clinical) [Ep 39 · 2:01](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=121)
- Inhaled nitric oxide is only started if there is evidence of a need — Paul Kingma (clinical) [Ep 39 · 2:05](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=125)
- The All Children's philosophy is that starting NG feeds before oral feeding capability causes babies to lose the developmental connection between oral feeding and satiety — Paul Kingma (opinion) [Ep 39 · 2:20](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=140)
- Babies are not fed enterally until they can feed by mouth; prior to that they receive TPN — Paul Kingma (clinical) [Ep 39 · 2:33](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=153)
- Every baby now gets started automatically on a continuous sedation drip — Paul Kingma (clinical) [Ep 39 · 2:47](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=167)
- Overall use of sedation has plummeted since starting universal continuous drips despite starting at a higher baseline level — Paul Kingma (clinical) [Ep 39 · 2:56](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=176)
- After protocol implementation, the patient population appears to be skewed to the extremes with slightly more severe and slightly more mild cases — Paul Kingma (epidemiological) [Ep 39 · 3:18](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=198)
- Survival increased from around 70% to around 80% after implementing protocol changes — Paul Kingma (epidemiological) [Ep 39 · 3:41](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=221)
- Median time on mechanical ventilation dropped from 19 days to 9 days, almost a 50% decline — Paul Kingma (epidemiological) [Ep 39 · 3:55](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=235)
- The philosophy of getting babies on ECMO sooner has not caused an increase in the number of ECMO babies — Paul Kingma (epidemiological) [Ep 39 · 4:19](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=259)
- There are many problems that CDH babies have beyond survival that need improvement — Paul Kingma (opinion) [Ep 39 · 4:40](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=280)
- In multivariate analysis of CDH repair complications, open repair is associated with higher risk of small bowel obstruction compared to MIS repair. (clinical) [Ep 4 · 0:01](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=1)
- Recurrence rates in primary CDH repairs were 3.9% for open and 7.8% for MIS repairs, a difference that was not statistically significant. (epidemiological) [Ep 4 · 0:20](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=20)
- Muscle flap repair for CDH is not feasible using minimally invasive technique. (clinical) [Ep 4 · 1:12](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=72)
- At Cincinnati Children's, zero recurrences occurred in muscle flap CDH patients over 10 years. (epidemiological) [Ep 4 · 1:40](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=100)
- Patients who received patches or other repair types had recurrences, but muscle flap patients did not. (clinical) [Ep 4 · 1:46](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=106)
- Primary CDH repairs represent a different patient population than those requiring muscle flap or Gore-Tex, making direct comparison problematic. (opinion) [Ep 4 · 2:00](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=120)
- For primary CDH repairs, laparoscopic or thoracoscopic approach offers better patient selection compared to open repair. (opinion) [Ep 4 · 2:23](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=143)
- All surgeons have high recurrence rates with patch repair for CDH except when using muscle flaps. (clinical) [Ep 4 · 2:38](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=158)
- For near-agenesis CDH defects (not complete agenesis), MIS repair resulted in poor outcomes despite technical success, similar to open repair outcomes. (clinical) [Ep 4 · 2:52](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=172)
- For large CDH defects, open repair is more expeditious than prolonged MIS attempts. (opinion) [Ep 4 · 3:20](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=200)
- For primary CDH repairs, thoracoscopic approach is a good option with potential to reduce recurrence by placing more sutures and ensuring adequate lateral corner closure. (opinion) [Ep 4 · 3:35](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=215)
- Biologic mesh used alone as a patch for CDH has a high recurrence rate. (clinical) [Ep 4 · 4:08](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=248)
- Biologic mesh for CDH repair has been largely abandoned by surgeons. (clinical) [Ep 4 · 4:16](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=256)
- Among CDH patients who have been on ECMO, 25% had defects small enough to be successfully repaired with laparoscopic approach. (epidemiological) [Ep 4 · 4:51](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=291)
- Initial laparoscopic assessment of CDH defect size adds only 5-10 minutes to operative time before converting to open if needed. (clinical) [Ep 4 · 5:15](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=315)
- Recent papers have addressed hypercapnia concerns during MIS CDH repair, requiring communication with anesthesiology. (clinical) [Ep 4 · 5:39](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=339)
- Echocardiography and TR jet measurement are essential to assess pulmonary hypertension in CDH patients, as pre- and post-ductal saturations alone are insufficient. — Todd Ponsky (clinical) [Ep 6 · 0:00](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=0)
- Jason waits until pulmonary pressures are subsystemic, at least 70% systemic and ideally 50% systemic, before proceeding to CDH repair. — Jason (clinical) [Ep 6 · 1:12](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=72)
- Jason uses serial echocardiography aggressively to monitor pulmonary pressures before surgery, typically waiting around 2 days. — Jason (clinical) [Ep 6 · 1:12](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=72)
- Jason performs thoracoscopic CDH repair in well-managed patients. — Jason (clinical) [Ep 6 · 1:59](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=119)
- Jason tried laparoscopic CDH repair early on and found it quite nice, but considers thoracoscopy an easier operation. — Jason (opinion) [Ep 6 · 2:05](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=125)
- Jason has started dissecting out the pleura to create a raw edge around the CDH defect. — Jason (clinical) [Ep 6 · 2:32](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=152)
- Sewing pleura to pleura without creating a raw edge may have a high failure rate analogous to laparoscopic inguinal hernia repair (sewing peritoneum to peritoneum). — Todd Ponsky (opinion) [Ep 6 · 2:35](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=155)
- Scoring the pleura all the way around and unfurling it so that it comes together with more of a scar may reduce recurrence. — Todd Ponsky (opinion) [Ep 6 · 2:35](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=155)
- A lamb model for studying CDH repair techniques would cost $5000 per lamb, making formal study prohibitively expensive. — Jason (clinical) [Ep 6 · 3:00](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=180)
- The speaker has a high degree of suspicion that pleural dissection will reduce CDH recurrence, but this has not been formally studied. — Jason (opinion) [Ep 6 · 3:00](https://team.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=180)
- Currently the institution does VA ECMO for CDH patients (clinical) [Ep 5 · 0:18](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=18)
- One institution performs VV ECMO with cephalad cannula for CDH patients and has been doing so since the late 1990s (clinical) [Ep 5 · 0:30](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=30)
- Conversion from VV to VA ECMO is exceedingly rare at this institution, approximately 3 cases in the last 10 years (epidemiological) [Ep 5 · 0:30](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=30)
- If an institution is really good at VV ECMO, they should do VV ECMO; if really good at VA ECMO, they should do VA ECMO — Todd Ponsky (opinion) [Ep 5 · 1:22](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=82)
- For underlay patches, SIS is used; for full patches, a composite of SIS on the abdominal side and Gore-Tex on the thoracic side is used (clinical) [Ep 5 · 2:02](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=122)
- The SIS underlay is secured by taking bites of the diaphragmatic leaf and mesh and tying, which causes some imbrication (clinical) [Ep 5 · 2:02](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=122)
- The Gore-Tex provides the security on the thoracic side, not the SIS (clinical) [Ep 5 · 2:02](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=122)
- Muscle flaps cause some abdominal wall weakness but not a true hernia because the transversus abdominus muscle is used as the flap (clinical) [Ep 5 · 3:20](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=200)
- Muscle flaps have not been found to cause a significant amount of scoliosis, no more than any other repair method (clinical) [Ep 5 · 3:20](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=200)
- Most CDH patients have issues with scoliosis when sutures are taken around the ribs and bite into the intercostal tissue, causing skeletal defects (clinical) [Ep 5 · 3:20](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=200)
- The risk of skeletal deformity is higher with patches (clinical) [Ep 5 · 3:50](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=230)
- During thoracoscopic repair, transient respiratory acidosis may occur but its clinical significance needs to be evaluated if it is not too severe (clinical) [Ep 5 · 4:04](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- For thoracoscopic CDH repair, very low insufflation pressures are used, with the highest being about 5 mmHg (clinical) [Ep 5 · 4:04](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- Once the viscera is reduced during thoracoscopic repair, insufflation can be turned off because pulmonary hypoplasia provides adequate domain without gas (clinical) [Ep 5 · 4:04](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- The period of insufflation during thoracoscopic CDH repair should be very short (clinical) [Ep 5 · 4:04](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- Aggressive hemofiltration and other measures can obviate some of the renal complications associated with VV ECMO (clinical) [Ep 5 · 5:31](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- If you have expertise in VA ECMO, you will not get as good results with VV ECMO and vice versa — Todd Ponsky (opinion) [Ep 5 · 7:17](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=437)
- You should do what you are good at regarding ECMO modality unless there is overwhelming evidence for one approach — Todd Ponsky (opinion) [Ep 5 · 7:17](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=437)
- For really poor prognosis CDH patients, aggressive repair in the first 24 to 48 hours on ECMO is performed (clinical) [Ep 5 · 8:02](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=482)
- For acute pulmonary hypertension crisis cases expected to be a short ECMO run, repair is delayed until off ECMO once echoes demonstrate subsystemic pulmonary hypertension (clinical) [Ep 5 · 8:02](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=482)
- For patients on ECMO for 2 or 3 weeks, repair is performed towards the end of the ECMO run (clinical) [Ep 5 · 8:02](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=482)
- The problem in CDH is not the hole in the diaphragm; that is not causing the pulmonary problems (clinical) [Ep 5 · 8:38](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=518)
- Some institutions will stop ECMO and not repair CDH in patients who cannot be weaned from ECMO — Todd Ponsky (clinical) [Ep 5 · 9:10](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=550)
- A scope is put in every CDH patient after ECMO at this institution (clinical) [Ep 5 · 9:32](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=572)
- Muscle flap mobilization and placement can potentially be done laparoscopically — Todd Ponsky (opinion) [Ep 5 · 10:09](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=609)
- Congenital diaphragmatic hernia is characterized by impaired fetal lung growth and maturation with unacceptably high mortality and morbidity rates. — Kasir Collaj (clinical) [Ep 11 · 1:13](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=73)
- One of the biggest challenges for babies with CDH is that fetal hypoplastic lungs are immature with impairment of cell differentiation, especially in the epithelium. — Kasir Collaj (clinical) [Ep 11 · 1:35](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=95)
- Extracellular vesicles (EVs) are the main mediators of stem cell paracrine signaling. — Kasir Collaj (clinical) [Ep 11 · 1:50](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=110)
- Amniotic fluid stem cell derived EVs can rescue fetal lung growth and maturation in several models of CDH at the pseudoglandular stage, which corresponds to 7 to 16 weeks of human gestation. — Kasir Collaj (clinical) [Ep 11 · 2:05](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=125)
- CDH is diagnosed around 18 to 20 weeks gestation. — Kasir Collaj (clinical) [Ep 11 · 2:35](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=155)
- The nitrophin model is a well-established model for studying CDH, created by administering the herbicide nitrophin to pregnant rat dams at embryonic day 9.5. — Kasir Collaj (clinical) [Ep 11 · 2:50](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=170)
- Hypoplastic lungs at canalicular and saccular stages show down-regulation of alveolar type 1 and 2 cells, as well as basal and club cells compared to control. — Kasir Collaj (clinical) [Ep 11 · 3:30](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=210)
- Treatment of hypoplastic lungs with amniotic fluid stem cell derived extracellular vesicles restores primary markers of alveolar type 1 and 2 cells, basal cells, and club cells, indicating that cell homeostasis can be achieved. — Kasir Collaj (clinical) [Ep 11 · 3:55](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=235)
- Most babies with congenital diaphragmatic hernia are diagnosed halfway during pregnancy, creating a window for potential prenatal interventions before birth. (clinical) [Ep 11 · 4:18](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=258)
- In vivo experiments have been performed in a rat model using different administration routes including intraamniotic and tracheal, with promising results. — Kasir Collaj (clinical) [Ep 11 · 5:26](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=326)
- There is active collaboration with Dr. Jan De Prest to investigate the safety and feasibility of EV treatment in a lab model. — Kasir Collaj (clinical) [Ep 11 · 6:20](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=380)
- Ciliated cells did not show a difference with EV treatment, potentially due to an imbalance of different cell types in the hypoplastic fetal lung creating a different homeostatic cell composition. — Kasir Collaj (clinical) [Ep 11 · 7:17](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=437)
- Key markers expressed in branching morphogenesis are being rescued effectively by EV treatment, suggesting the importance is the greater cell homeostatic balance rather than any specific cell type. — Kasir Collaj (clinical) [Ep 11 · 7:40](https://team.globalcastmd.com/watch/best-of-the-best-in-pediatric-surgery-winner-announcement-5321?t=460)
- Congenital diaphragmatic hernia is characterized by impaired fetal lung growth and maturation with unacceptably high mortality and morbidity rates. — Kasra Khalaj (clinical) [Ep 12 · 0:29](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=29)
- One of the biggest challenges for babies with CDH is that fetal hypoplastic lungs are immature with impairment of cell differentiation, especially in the epithelium. — Kasra Khalaj (clinical) [Ep 12 · 1:00](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=60)
- Extracellular vesicles (EVs) are the main mediators of stem cell paracrine signaling. — Kasra Khalaj (clinical) [Ep 12 · 1:15](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=75)
- In a recently published proof of concept study, amniotic fluid stem cell derived EVs can rescue fetal lung growth and maturation in several models of CDH at the pseudoglandular stage, which corresponds to 7 to 16 weeks of human gestation. — Kasra Khalaj (clinical) [Ep 12 · 1:25](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=85)
- CDH is diagnosed around 18 to 20 weeks of human gestation. — Kasra Khalaj (clinical) [Ep 12 · 1:55](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=115)
- The canalicular and saccular stages are translationally relevant developmental stages for CDH intervention, corresponding to the time when diagnosis occurs. — Kasra Khalaj (clinical) [Ep 12 · 1:55](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=115)
- The nitrofen model is a well-established model for studying CDH, created by administering the herbicide nitrofen to pregnant rat dams at embryonic day 9.5. — Kasra Khalaj (clinical) [Ep 12 · 2:15](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=135)
- Key epithelial populations in the fetal lung include alveolar type 1 and type 2 cells (primarily comprising the alveolus) and club, ciliated, and basal cells (mainly comprising the bronchi and bronchioles). — Kasra Khalaj (clinical) [Ep 12 · 2:35](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=155)
- Hypoplastic lungs at canalicular and saccular stages show downregulation of alveolar type 1 and 2 cells, as well as basal and club cells compared to control lungs. — Kasra Khalaj (clinical) [Ep 12 · 2:55](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=175)
- Treatment of hypoplastic lungs with amniotic fluid stem cell derived extracellular vesicles restores primary epithelial cell markers, indicating that cell homeostasis can be achieved. — Kasra Khalaj (clinical) [Ep 12 · 3:10](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=190)
- In vivo experiments using intraamniotic and tracheal administration routes of extracellular vesicles in rat models have shown promising results. — Kasra Khalaj (clinical) [Ep 12 · 4:42](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=282)
- Safety and feasibility studies of AFSC-EV treatment are being investigated in collaboration with Jan Deprest in a lamb model. — Kasra Khalaj (clinical) [Ep 12 · 5:36](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=336)
- Ciliated cells in hypoplastic CDH lungs did not show rescue with AFSC-EV treatment, which may reflect achievement of a different homeostatic cell composition rather than failure of the therapy. — Kasra Khalaj (clinical) [Ep 12 · 6:33](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=393)
- Key markers of branching morphogenesis are being rescued effectively by AFSC-EV treatment. — Kasra Khalaj (clinical) [Ep 12 · 7:00](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=420)
- We know halfway during pregnancy that babies with CDH are going to be born with abnormal lung development, creating an opportunity for prenatal interventions. — Richard Keijzer (opinion) [Ep 12 · 4:00](https://team.globalcastmd.com/watch/caps-administration-of-amniotic-fluid-stem-cell-extracellular-vesicles-regenerates-the-lung-epithelium-in-fetal-rats-with-cdh-at-translationally-relevant-developmental-stages-kasra-khalaj-5421?t=240)
- Prenatal diagnosis and prognostication of CDH cases relies currently only on imaging modalities, with sensitivity for CDH cases around 70%. — Richard Wagner (clinical) [Ep 14 · 0:21](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=21)
- Circular RNAs are an RNA species with a circular shape that is highly stable in biofluids and has potential as biomarkers in several human disease contexts. — Richard Wagner (clinical) [Ep 14 · 1:40](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=100)
- Circular RNA profiles are significantly altered between CDH and control fetal lungs at two different developmental time points. — Richard Wagner (clinical) [Ep 14 · 2:10](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=130)
- The microarray profiling detected approximately 12,000 circular RNAs in fetal lung tissue samples. — Richard Wagner (clinical) [Ep 14 · 2:40](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=160)
- An algorithm could successfully cluster CDH lungs and control lungs into two separate groups based on circular RNA profiles at both developmental time points investigated. — Richard Wagner (clinical) [Ep 14 · 3:00](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=180)
- Amniotic fluid samples were obtained from CDH cases undergoing fetal tracheal occlusion. — Richard Wagner (clinical) [Ep 14 · 3:30](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=210)
- At the time point of amniotic fluid sampling, observed over expected lung to head ratio was similar between survivors and non-survivors. — Richard Wagner (clinical) [Ep 14 · 3:50](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=230)
- Gestational age, liver herniation, and birth weight did not differ between CDH survivors and non-survivors at the time of amniotic fluid sampling. — Richard Wagner (clinical) [Ep 14 · 4:20](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=260)
- Circular RNA profiles isolated from amniotic fluid samples can distinguish between CDH survivors and non-survivors, indicating prognostic value superior to current imaging modalities. — Richard Wagner (clinical) [Ep 14 · 4:40](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=280)
- The research goal is to validate these biomarkers in amniotic fluids in a larger and independent clinical cohort and define 2 to 3 markers that can predict outcomes in CDH cases. — Richard Wagner (opinion) [Ep 14 · 5:10](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=310)
- The team plans to test whether circular RNA markers can be isolated from maternal blood samples instead of amniotic fluid. — Richard Wagner (opinion) [Ep 14 · 5:10](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=310)
- The COVID pandemic impacted the study by limiting patient recruitment and CDH case enrollment. — Richard Wagner (clinical) [Ep 14 · 6:01](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=361)
- The initial study was a screening experiment that profiled all detectable circular RNAs in samples. — Richard Wagner (clinical) [Ep 14 · 6:30](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=390)
- The team received funding from the Canadian Institutes of Health Research for a multi-center study to increase sample size and validate findings. — Richard Wagner (clinical) [Ep 14 · 6:50](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=410)
- The study is not currently powered to stratify cases of syndromic CDH versus non-syndromic CDH or different severity levels. — Richard Wagner (clinical) [Ep 14 · 8:09](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=489)
- Based on prior work with circular RNAs in CDH lungs, the researchers believe they have a disease-specific marker. — Richard Wagner (opinion) [Ep 14 · 8:09](https://team.globalcastmd.com/watch/eupsa-circular-rna-profiles-isolated-from-amniotic-fluidscan-distinguish-between-cdh-survivors-and-non-survivers-richard-wagner-5431?t=489)
- Primary Children's Hospital ECMO program was established in 2003, with first CDH protocol implemented in 2007 — Steven Fenton (clinical) [Ep 16 · 0:21](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=21)
- The 2016 CDH protocol change places infants in a quiet NICU area for the first 72 hours with immediate intubation on high frequency oscillator and decreased mean airway pressure — Steven Fenton (clinical) [Ep 16 · 0:50](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=50)
- The protocol minimizes stimulation by using transport-capable beds to avoid moving the infant between beds — Steven Fenton (clinical) [Ep 16 · 1:50](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=110)
- Echo is not performed within the first 24 hours if a prenatal echo already exists — Steven Fenton (clinical) [Ep 16 · 2:05](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=125)
- Oxygen is weaned according to preductal saturations only, with no routine postductal saturation monitoring — Steven Fenton (clinical) [Ep 16 · 2:15](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=135)
- Oxygen resuscitation starts at FIO2 of 0.4 instead of 1.0 — Steven Fenton (clinical) [Ep 16 · 2:30](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=150)
- Inhaled nitric oxide and other vasodilators or pressor agents are used only for clinically significant hypoperfusion — Steven Fenton (clinical) [Ep 16 · 2:38](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=158)
- Median mean airway pressure decreased from 13 to 11 after protocol implementation — Steven Fenton (clinical) [Ep 16 · 2:45](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=165)
- Higher mean airway pressures compromise gas exchange and lung vascularization, potentially increasing pulmonary hypertension — Steven Fenton (clinical) [Ep 16 · 3:15](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=195)
- The protocol is applied to all prenatally diagnosed CDH cases regardless of severity — Steven Fenton (clinical) [Ep 16 · 3:26](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=206)
- ECMO utilization rate decreased from 37% to 13% after protocol implementation — Steven Fenton (clinical) [Ep 16 · 3:40](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=220)
- Overall survival increased from 74% to 89%, a statistically significant change — Steven Fenton (clinical) [Ep 16 · 4:05](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=245)
- Survival was significantly improved for liver-down CDH cases — Steven Fenton (clinical) [Ep 16 · 4:20](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=260)
- Survival increased for liver-up CDH cases but was not statistically significant — Steven Fenton (clinical) [Ep 16 · 4:30](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=270)
- Survival without ECMO use increased after protocol implementation — Steven Fenton (clinical) [Ep 16 · 4:40](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=280)
- Since 2016, 97% of CDH cases received prenatal MRI compared to 24% before the fetal center was established — Steven Fenton (clinical) [Ep 16 · 5:12](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=312)
- In the study period since 2016, there were 53 isolated left CDH cases after exclusions — Steven Fenton (clinical) [Ep 16 · 5:40](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=340)
- Among infants with MRI total fetal lung volume observed-to-expected less than 15%, ECMO utilization was 38% rather than the expected 100% — Steven Fenton (clinical) [Ep 16 · 5:55](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=355)
- ECMO criteria include PaO2 never rising above 50 and inability to get CO2 levels below 100 — Steven Fenton (clinical) [Ep 16 · 6:30](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=390)
- The MRI less than 15% group had 50% survival — Steven Fenton (clinical) [Ep 16 · 6:50](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=410)
- The CDH protocol is implemented uniformly by all neonatologists in the closed NICU unit, not by select individual providers — Steven Fenton (clinical) [Ep 16 · 8:15](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=495)
- The hardest aspect of implementing the protocol was changing the culture around practices like routine early echocardiography, immediate transport, and postductal saturation monitoring — Steven Fenton (opinion) [Ep 16 · 9:00](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=540)
- The study compared giant omphalocele outcomes in infants born before 34 weeks gestational age versus after 34 weeks — Uchenna Kennedy (clinical) [Ep 16 · 10:00](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=600)
- Neonatal intubation requirement was significantly higher in the preterm giant omphalocele group — Uchenna Kennedy (clinical) [Ep 16 · 10:50](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=650)
- Tracheostomy and ventilator dependence at discharge occurred at a rate of 31% in the preterm giant omphalocele group, though not statistically significant — Uchenna Kennedy (clinical) [Ep 16 · 11:05](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=665)
- Neonatal death rate was 26% in the preterm giant omphalocele group versus 6% in the term group, a statistically significant difference — Uchenna Kennedy (clinical) [Ep 16 · 11:25](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=685)
- 34 weeks was chosen as the cutoff for preterm versus term based on fetal lung maturity being significantly better after 34 weeks — Uchenna Kennedy (clinical) [Ep 16 · 11:24](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=684)
- Three main prenatal findings suggest esophageal atresia: polyhydramnios, small stomach, and distended proximal esophageal pouch — Oliulinka Olutoye (clinical) [Ep 16 · 11:46](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=706)
- Postnatal radiographs showing air in the stomach confirm the presence of a distal tracheoesophageal fistula — Oliulinka Olutoye (clinical) [Ep 16 · 12:30](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=750)
- The study classified prenatal stomach size as absent (no visible fluid), small amount of fluid, or normal sized — Oliulinka Olutoye (clinical) [Ep 16 · 12:50](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=770)
- Almost all cases of pure esophageal atresia had a small stomach on prenatal imaging — Oliulinka Olutoye (clinical) [Ep 16 · 13:10](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=790)
- 43% of cases with distal tracheoesophageal fistula also had a small stomach on prenatal imaging — Oliulinka Olutoye (clinical) [Ep 16 · 13:30](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=810)
- Small stomach size on prenatal imaging does not reliably discriminate between pure esophageal atresia and EA with tracheoesophageal fistula — Oliulinka Olutoye (clinical) [Ep 16 · 13:45](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=825)
- The study included both ultrasound and MRI imaging, and neither modality could distinguish pure EA from EA with TEF based on stomach appearance — Oliulinka Olutoye (clinical) [Ep 16 · 14:02](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=842)
- There are no current guidelines for mental health screening in mothers with prenatally diagnosed fetal anomalies — Nina Bentz (guideline) [Ep 16 · 14:50](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=890)
- The study enrolled patients at their first fetal concern center visit and administered three surveys at different time points: before surgeon consultation, after surgeon consultation, and following delivery — Nina Bentz (clinical) [Ep 16 · 15:05](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=905)
- The surveys assessed five validated measures including depression, anxiety, PTSD, and resilience — Nina Bentz (clinical) [Ep 16 · 15:45](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=945)
- Over one-third of mothers with prenatally diagnosed fetal anomalies screened positive for depression, anxiety, and PTSD — Nina Bentz (clinical) [Ep 16 · 16:00](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=960)
- Only 25% to 33% of mothers who screened positive for mental health disorders had prior histories of psychiatric diagnoses — Nina Bentz (clinical) [Ep 16 · 16:15](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=975)
- Overall resilience scores were lower in the study population of mothers with prenatally diagnosed fetal anomalies — Nina Bentz (clinical) [Ep 16 · 16:30](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=990)
- There was no difference in mental health screening results between pre-consultation and post-consultation surveys with the pediatric surgeon — Nina Bentz (clinical) [Ep 16 · 17:10](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=1030)
- The majority of fetal anomaly diagnoses in the study were rated in the mid-severity range by both surgeons and mothers — Nina Bentz (clinical) [Ep 16 · 16:28](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=988)
- Health disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care — Shelby Sferra (epidemiological) [Ep 17 · 3:26](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=206)
- In CDH, disparities affect care from prenatal diagnosis and surveillance through postnatal management — Shelby Sferra (clinical) [Ep 17 · 3:40](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=220)
- The study cohort included 1,625 CDH patients from PHIS database 2015-2020 — Shelby Sferra (epidemiological) [Ep 17 · 4:30](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=270)
- Hospital volume was defined as less than 10 CDH cases per year as low volume and 10 or more cases as high volume — Shelby Sferra (clinical) [Ep 17 · 4:50](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=290)
- Institutional racial and ethnic diversity was defined as the percentage of black and/or Hispanic CDH patients treated at each institution, stratified from less than 20% to greater than 40% — Shelby Sferra (clinical) [Ep 17 · 5:05](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=305)
- Household incomes of black and Hispanic patients were significantly lower than that for white patients — Shelby Sferra (epidemiological) [Ep 17 · 5:40](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=340)
- White and Asian patients had primarily commercial insurance, whereas black and Hispanic patients had largely Medicaid payer status — Shelby Sferra (epidemiological) [Ep 17 · 5:50](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=350)
- Black patients were born at significantly lower gestational ages and were more likely to be born preterm — Shelby Sferra (clinical) [Ep 17 · 6:10](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=370)
- Black CDH patients had lower birth weights and lower Apgar scores compared to white patients — Shelby Sferra (clinical) [Ep 17 · 6:20](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=380)
- Black patients were cannulated to extracorporeal life support more often than white patients — Shelby Sferra (clinical) [Ep 17 · 6:30](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=390)
- Black CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer — Shelby Sferra (clinical) [Ep 17 · 6:40](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=400)
- These differences in disease severity were not seen in Hispanic and Asian patients when compared to white patients — Shelby Sferra (clinical) [Ep 17 · 6:50](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=410)
- Black CDH patients were admitted for significantly longer, discharged home less often, and were more likely to require a tracheostomy at discharge — Shelby Sferra (clinical) [Ep 17 · 7:05](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=425)
- Black patients had decreased in-hospital survival rates of 79% compared to 88% in white patients — Shelby Sferra (epidemiological) [Ep 17 · 7:20](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=440)
- Hispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively — Shelby Sferra (epidemiological) [Ep 17 · 7:30](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=450)
- Low institutional diversity levels (less than 20% minority patients) were associated with decreased survival in white, black, and Hispanic CDH patients — Shelby Sferra (epidemiological) [Ep 17 · 7:45](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=465)
- Higher levels of institutional diversity (between 31 and 40% minority patients) were associated with improved survival for white, black, and Hispanic CDH patients — Shelby Sferra (epidemiological) [Ep 17 · 8:00](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=480)
- Differences in survival based on institutional diversity were not observed in Asian patients — Shelby Sferra (epidemiological) [Ep 17 · 8:15](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=495)
- Cox regression analysis controlling for severity, socioeconomic status, and institutional covariants showed white patients had comparable outcomes regardless of institutional diversity — Shelby Sferra (epidemiological) [Ep 17 · 8:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=502)
- Institutions with greater than 30% diversity conferred a protective effect against mortality for black CDH patients treated there — Shelby Sferra (epidemiological) [Ep 17 · 8:40](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=520)
- Institutions with diversity greater than 20% conferred a protective effect for Hispanic CDH patients — Shelby Sferra (epidemiological) [Ep 17 · 8:55](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=535)
- Treating a more racially and ethnically diverse patient population improves outcomes for black and Hispanic CDH patients without negatively impacting white patients — Shelby Sferra (clinical) [Ep 17 · 9:05](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=545)
- Many of the disparities in CDH outcomes are related to socioeconomic and other issues (opinion) [Ep 17 · 10:50](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=650)
- Health disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care. — Shelby Sferra (epidemiological) [Ep 21 · 0:10](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=10)
- In congenital diaphragmatic hernia (CDH), racial and ethnic disparities affect care from prenatal diagnosis and surveillance through postnatal management. — Shelby Sferra (epidemiological) [Ep 21 · 0:30](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=30)
- The study cohort included 1,625 CDH patients from the FIS database (2015-2020) admitted on day of life zero with ICD diagnosis code for CDH and procedure code for repair. — Shelby Sferra (clinical) [Ep 21 · 1:30](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=90)
- Hospital volume was defined as less than 10 CDH cases per year (low volume) and 10 or more cases per year (high volume). — Shelby Sferra (clinical) [Ep 21 · 2:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=120)
- Institutional racial and ethnic diversity was defined as the percentage of Black and/or Hispanic CDH patients treated at each institution, stratified into levels from less than 20% to greater than 40%. — Shelby Sferra (clinical) [Ep 21 · 2:15](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=135)
- Household incomes of Black and Hispanic CDH patients were significantly lower than that for white patients. — Shelby Sferra (epidemiological) [Ep 21 · 2:30](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=150)
- White and Asian CDH patients had primarily commercial insurance, whereas Black and Hispanic patients had largely Medicaid payer status. — Shelby Sferra (epidemiological) [Ep 21 · 2:40](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=160)
- Black CDH patients were born at significantly lower gestational ages and were more likely to be born preterm compared to white patients. — Shelby Sferra (clinical) [Ep 21 · 2:50](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=170)
- Black CDH patients had lower birth weights and lower Apgar scores compared to white patients. — Shelby Sferra (clinical) [Ep 21 · 3:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=180)
- Black CDH patients were cannulated to extracorporeal life support (ECMO) more often than white patients. — Shelby Sferra (clinical) [Ep 21 · 3:05](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=185)
- Black CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer compared to white patients. — Shelby Sferra (clinical) [Ep 21 · 3:12](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=192)
- Disease severity differences observed in Black CDH patients were not seen in Hispanic and Asian patients when compared to white patients. — Shelby Sferra (clinical) [Ep 21 · 3:20](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=200)
- Black CDH patients were admitted for significantly longer hospital stays compared to white patients. — Shelby Sferra (clinical) [Ep 21 · 3:30](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=210)
- Black CDH patients were discharged home less often than white patients. — Shelby Sferra (clinical) [Ep 21 · 3:35](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=215)
- Black CDH patients were more likely to require a tracheostomy at the time of discharge compared to white patients. — Shelby Sferra (clinical) [Ep 21 · 3:40](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=220)
- Black CDH patients had decreased in-hospital survival rates of 79% compared to 88% in white patients. — Shelby Sferra (clinical) [Ep 21 · 3:45](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=225)
- Hispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively. — Shelby Sferra (clinical) [Ep 21 · 3:52](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=232)
- Low institutional diversity levels (less than 20% Black and/or Hispanic patients) were associated with decreased survival in white, Black, and Hispanic CDH patients. — Shelby Sferra (clinical) [Ep 21 · 4:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=240)
- Higher institutional diversity levels (31-40% Black and/or Hispanic patients) were associated with improved survival for white, Black, and Hispanic CDH patients. — Shelby Sferra (clinical) [Ep 21 · 4:15](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=255)
- Institutional diversity effects on survival were not observed in Asian CDH patients. — Shelby Sferra (clinical) [Ep 21 · 4:25](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=265)
- Cox regression analysis controlling for disease severity, socioeconomic status, and institutional covariates including hospital volume showed that white CDH patients had comparable outcomes regardless of institutional diversity level. — Shelby Sferra (clinical) [Ep 21 · 4:30](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=270)
- Institutions with greater than 30% racial/ethnic diversity conferred a protective effect against mortality for Black CDH patients treated there. — Shelby Sferra (clinical) [Ep 21 · 4:40](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=280)
- Institutions with diversity greater than 20% conferred a protective effect against mortality for Hispanic CDH patients treated there. — Shelby Sferra (clinical) [Ep 21 · 4:48](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=288)
- Treating a more racially and ethnically diverse CDH patient population improves outcomes for Black and Hispanic patients without negatively impacting white patients. — Shelby Sferra (clinical) [Ep 21 · 4:55](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=295)
- Some FETO patients still required ECMO, but some avoided ECMO due to the fetal intervention — Todd Ponsky (clinical) [Ep 24 · 2:43](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=163)
- Centers with high CDH volume doing ECMO achieve survival of almost 50% or more in severe CDH — Fernando Bullettin (epidemiological) [Ep 24 · 3:02](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=182)
- Not all centers in the European FETO trials used ECMO, which may affect the apparent benefit of FETO — Fernando Bullettin (clinical) [Ep 24 · 3:02](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=182)
- In Europe, some maternal-fetal medicine centers perform FETO but then transfer patients to other centers for delivery and neonatal care — Fernando Bullettin (clinical) [Ep 24 · 4:11](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=251)
- In Chile during training, the protocol was to place babies on ECMO as a 'trial for life,' then decannulate and perform repair if the baby survived — Jose Campos (clinical) [Ep 24 · 5:00](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=300)
- A protocol of very early repair (8-10 hours after ECMO cannulation at 6-8 hours of life) has been implemented, though the speaker's feeling is it may not be doing better — Fernando Bullettin (clinical) [Ep 24 · 5:18](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=318)
- At least 4 reports confirm the data favoring early on-ECMO repair, representing a practice change — Fernando Bullettin (clinical) [Ep 24 · 7:04](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=424)
- Thoracoscopic CDH repair is performed if the baby can go to the operating room, unless a patch is needed or the baby is too sick, in which case open repair in the NICU is preferred — Todd Ponsky (clinical) [Ep 24 · 7:37](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=457)
- Most commonly open approach is used; thoracoscopy is reserved for babies who don't need oxygen in the NICU, and conversion to open occurs if a patch is needed — Fernando Bullettin (clinical) [Ep 24 · 7:49](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=469)
- Prolonged operative time required for thoracoscopic repair in babies requiring inotropes or special ventilation (increasing CO2, decreasing pH) is not good for the patient — Fernando Bullettin (opinion) [Ep 24 · 9:04](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=544)
- Possible explanations for higher thoracoscopic recurrence include: insufficient scar formation, inadequate diaphragm unfurling, taking bites at the same level creating a muscle bundle that pulls away, or insufficient number of sutures — Todd Ponsky (clinical) [Ep 24 · 9:57](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=597)
- Choice between muscle flap and mesh depends on the defect characteristics; mesh is usually used, but flap is chosen if there is good lift of diaphragm posteriorly — Fernando Bullettin (clinical) [Ep 24 · 10:43](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=643)
- A lower transverse incision (rather than subcostal) allows intraoperative decision-making between flap and mesh based on defect size, making mesh repair slightly more difficult but not impossible — Jose Campos (clinical) [Ep 24 · 11:11](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=671)
- Biologic patches should never be used by themselves as they are not designed to be a bridge; they can be used to reinforce a synthetic patch on top — Todd Ponsky (clinical) [Ep 24 · 13:06](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=786)
- Skeletal deformity is part of the CDH disease itself, making it unclear whether chest deformity is due to the patch or the underlying condition — Fernando Bullettin (clinical) [Ep 24 · 14:32](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=872)
- Synthetic patches pulling on ribs causing chest deformity makes sense in type A-D defects, but these defects are very rare — Fernando Bullettin (clinical) [Ep 24 · 14:32](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=872)
- Fundoplication is performed in type D defect patients who are on ECMO — Fernando Bullettin (clinical) [Ep 24 · 15:19](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=919)
- In the speaker's experience with type D ECMO patients receiving fundoplication, no subsequent surgery for reflux has been needed, representing definitive repair of both CDH and fundoplication — Fernando Bullettin (clinical) [Ep 24 · 16:21](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=981)
- FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus. — Beth Rymeski (clinical) [Ep 42 · 0:33](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=33)
- A standard fetoscope with a side channel is used, and the balloon is worked through the side channel. — Beth Rymeski (clinical) [Ep 42 · 0:36](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=36)
- The tongue is a very easy landmark when doing a FETO because it is bumpy. — Beth Rymeski (clinical) [Ep 42 · 1:21](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=81)
- Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement. — Beth Rymeski (clinical) [Ep 42 · 1:29](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=89)
- If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth. — Beth Rymeski (clinical) [Ep 42 · 1:38](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=98)
- The epiglottis is sought as a landmark to guide navigation toward the trachea. — Beth Rymeski (clinical) [Ep 42 · 1:58](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=118)
- Excessive torquing of the membranes should be avoided because the trocar goes through the abdominal and uterine walls, and excessive turning can cause membrane damage. — Beth Rymeski (clinical) [Ep 42 · 2:23](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=143)
- The scope is always advanced until the carina is seen, which confirms tracheal position and ensures the scope did not accidentally enter the esophagus. — Beth Rymeski (clinical) [Ep 42 · 2:36](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=156)
- The balloon should not be driven into one side of the trachea; it should inflate in the main trachea. — Beth Rymeski (clinical) [Ep 42 · 2:56](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=176)
- The scope is backed up as the balloon is inflated so that balloon inflation can be watched. — Beth Rymeski (clinical) [Ep 42 · 3:03](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=183)
- The cutoff for severe CDH O/E (observed to expected lung to head ratio) on ultrasound is 25%. — Beth Rymeski (guideline) [Ep 44 · 1:44](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=104)
- When the left lobe of the liver is touching the apex of the left chest in left-sided CDH, the entire hemi-liver has herniated into that side of the chest. — Beth Rymeski (clinical) [Ep 44 · 0:50](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=50)
- In this case, there was a 42% increase in lung volume between balloon placement and removal (left lung volume increased from 1 mL to 23 mL). — Beth Rymeski (clinical) [Ep 44 · 2:45](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=165)
- For a C-section delivery less than a week after FETO balloon removal, intubation on support and surfactant administration were performed. — Beth Rymeski (clinical) [Ep 44 · 3:05](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=185)
- Extubation at 26 days old is pretty good for a severe CDH. — Beth Rymeski (opinion) [Ep 44 · 3:43](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=223)
- Discharge at day of life 94 (about three months old) is pretty good for severe CDH. — Beth Rymeski (opinion) [Ep 44 · 4:02](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=242)
- Tracheal dilation is a very common finding in babies who had tracheal occlusion because the trachea was stretched out during the course of the pregnancy. — Beth Rymeski (clinical) [Ep 44 · 4:15](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=255)
- Tracheal dilation after FETO is not felt to be clinically impactful in the long run based on follow-up data from kids in Europe. — Beth Rymeski (clinical) [Ep 44 · 4:24](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=264)
- Initial respiratory management included Vyvent (APRV setting), then oscillator, with low dose fentanyl to support blood pressure, eventually returning to Vyvent vent settings. — Beth Rymeski (clinical) [Ep 44 · 3:25](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=205)
- The patient was a 33-year-old G3P2 diagnosed with CDH on routine 20-week ultrasound and seen at around 24 weeks. — Beth Rymeski (clinical) [Ep 43 · 0:29](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=29)
- The left lung was so small they couldn't even get a measurement (less than 1 mL). — Beth Rymeski (clinical) [Ep 43 · 0:42](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=42)
- The O/E by trace was 14%. — Beth Rymeski (clinical) [Ep 43 · 0:49](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=49)
- This case represents severe, severe CDH. — Beth Rymeski (clinical) [Ep 43 · 0:59](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=59)
- While the balloon was in place, the lungs showed some growth but it was shy of 20%, making this a non-responder. — Beth Rymeski (clinical) [Ep 43 · 1:14](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=74)
- There was some interval growth in the right lung, but overall still really poor numbers. — Beth Rymeski (clinical) [Ep 43 · 1:40](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=100)
- The baby was immediately put on ECMO in the delivery room. — Beth Rymeski (clinical) [Ep 43 · 1:58](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=118)
- The baby had only 6 pairs of ribs at the time of birth, missing a lot of ribs. — Beth Rymeski (clinical) [Ep 43 · 2:09](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=129)
- The baby had a spinal kyphosis. — Beth Rymeski (clinical) [Ep 43 · 2:17](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=137)
- The baby had no anus (anorectal malformation). — Beth Rymeski (clinical) [Ep 43 · 2:17](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=137)
- The cardiac anatomy was determined to be a right dominant double aortic arch with narrowing on the right and atresia on the left, after considerable back and forth about the actual anatomy. — Beth Rymeski (clinical) [Ep 43 · 2:29](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=149)
- The baby remained on ECMO for several weeks. — Beth Rymeski (clinical) [Ep 43 · 2:48](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=168)
- Multiple attempts were made to wean off ECMO; the team could get down to a certain point but could never get below that threshold. — Beth Rymeski (clinical) [Ep 43 · 2:52](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=172)
- After discussion with the family, they decided to withdraw support, and the baby passed around 3 weeks of life, never making it off ECMO. — Beth Rymeski (clinical) [Ep 43 · 3:06](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=186)
- Radiology reviewed the prenatal imaging retrospectively, knowing what was found postnatally, and still could not identify the rib, spinal, and cardiac anomalies. — Beth Rymeski (clinical) [Ep 43 · 3:14](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=194)
- Despite advanced prenatal imaging, we still miss some pretty significant findings. — Beth Rymeski (opinion) [Ep 43 · 3:22](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=202)
- CDH occurs in approximately 1 in 3,000 births — Paul Kingma (epidemiological) [Ep 38 · 0:21](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=21)
- Referral centers tend to see 20 to 30 CDH babies per year — Paul Kingma (epidemiological) [Ep 38 · 0:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=40)
- CDH anatomy is variable, and variability greatly impacts patient survival — Paul Kingma (clinical) [Ep 38 · 0:50](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=50)
- Initial ultrasound at roughly 20 weeks of pregnancy often identifies CDH and potentially other anomalies that can greatly impact outcome — Paul Kingma (clinical) [Ep 38 · 1:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=60)
- Overall survival for infants born with CDH remains static at about 70% over the past two decades despite intensive efforts to improve care — Paul Kingma (epidemiological) [Ep 38 · 1:30](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=90)
- Imaging findings such as fetal lung volumes, liver herniation, and lung to head ratio contribute to prognosis — Paul Kingma (clinical) [Ep 38 · 1:50](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=110)
- Cincinnati Children's has an MRI in their NICU which allows easy postnatal imaging for CDH babies both before and after repair — Paul Kingma (clinical) [Ep 38 · 2:30](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=150)
- Ultra-short echo T MRI technique allows determination of lung volumes, lung density, and lung mass postnatally — Paul Kingma (clinical) [Ep 38 · 3:10](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=190)
- In a cohort of 13 babies at Cincinnati Children's with postnatal imaging compared to fetal MRI, the lungs do grow postnatally with increases in total lung volume, right lung volume, and left lung volume — Paul Kingma (clinical) [Ep 38 · 3:30](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=210)
- The non-CDH or good lung (right lung) grew better than the left side lung — Paul Kingma (clinical) [Ep 38 · 3:55](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=235)
- The left lung was growing at about 2 mL per week slower than the right lung — Paul Kingma (clinical) [Ep 38 · 4:05](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=245)
- The relative growth of the left lung increased in babies that had better weight gain — Paul Kingma (clinical) [Ep 38 · 4:15](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=255)
- Maximizing calories and protein intake is important for CDH patients to maximize growth, as growth is associated with better growth of the more severely hypoplastic lung — Paul Kingma (clinical) [Ep 38 · 4:25](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=265)
- Babies who gained weight better had more growth of their left lung mass but did not impact the mass of the right lung — Paul Kingma (clinical) [Ep 38 · 4:40](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=280)
- 2D time-of-flight MRI sequence can detect blood vessels in the lungs down to a size of 0.7 millimeters — Paul Kingma (clinical) [Ep 38 · 4:50](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=290)
- Vascular density is calculated by dividing the volume of blood vessels by the volume of the lungs — Paul Kingma (clinical) [Ep 38 · 5:00](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=300)
- CDH pulmonary vascular density correlated very strongly with outcomes in babies with CDH — Paul Kingma (clinical) [Ep 38 · 5:10](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=310)
- Lower vascular density correlates with longer time spent on the ventilator — Paul Kingma (clinical) [Ep 38 · 5:20](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=320)
- Babies discharged on room air had significantly higher vascular density than those discharged on oxygen or mechanical ventilation — Paul Kingma (clinical) [Ep 38 · 5:30](https://team.globalcastmd.com/watch/congenital-diaphragmatic-hernias-improving-outcomes-with-advanced-imaging-nutrition-12113?t=330)
- Bivalirudin eliminates concerns about heparin-induced thrombocytopenia (HIT) and falling antithrombin III (AT3) levels. — Rebecca Stark (clinical) [Ep 37 · 0:39](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=39)
- Bivalirudin is used predominantly as the sole anticoagulant drip for most ECMO cases at the speaker's institution. — Steven Lee (clinical) [Ep 37 · 1:02](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=62)
- Most places still use heparin for ECMO anticoagulation, but the practice is shifting quickly toward bivalirudin. — Steven Lee (opinion) [Ep 37 · 1:02](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=62)
- Transitioning to early CDH repair on ECMO is challenging for lower-volume institutions (one or two cases per year) and requires buy-in from the entire team. — Rebecca Stark (opinion) [Ep 37 · 2:21](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=141)
- Building team buy-in for early repair requires showing data and assembling a dedicated team including anesthesiologists and neonatologists willing to operate in the OR and on weekends. — Steven Lee (clinical) [Ep 37 · 2:42](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=162)
- With bivalirudin, surgical repair can be performed as early as 8 hours after ECMO initiation once levels are stable, which happens quickly. — Steven Lee (clinical) [Ep 37 · 2:42](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=162)
- Early repair on ECMO results in much less tissue edema, making it very similar to performing repair off ECMO. — Steven Lee (clinical) [Ep 37 · 2:42](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=162)
- The majority of centers still do VA ECMO primarily for CDH babies. — Steven Lee (clinical) [Ep 36 · 1:33](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=93)
- Both VA and VV ECMO answers are totally reasonable for severe CDH. — Steven Lee (opinion) [Ep 36 · 1:33](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=93)
- There are lots of benefits to VV and lots of benefits to VA ECMO. — Steven Lee (clinical) [Ep 36 · 1:33](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=93)
- The time to intervene with ECMO in high-risk CDH is probably earlier rather than later. — Rebecca Stark (opinion) [Ep 36 · 1:57](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=117)
- VV cannula availability and concerns with certain VV cannulas have played a role in ECMO mode selection. — Rebecca Stark (clinical) [Ep 36 · 1:57](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=117)
- In cases of large congenital diaphragmatic hernia defects, diaphragmatic replacements are used, most commonly synthetic patches such as PTFE or Gore-Tex. — Christina Theodorou (clinical) [Ep 22 · 0:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=0)
- Synthetic patches for diaphragmatic hernia repair are associated with significant morbidity including hernia recurrence, bowel obstructions, and chest wall deformities as the child grows. — Christina Theodorou (clinical) [Ep 22 · 0:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=0)
- The ideal diaphragm replacement would integrate with native tissue, mechanically match the function of the diaphragm and allow for growth with the child. — Christina Theodorou (opinion) [Ep 22 · 0:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=0)
- Biodegradable forms of polyurethane have been used in tissue repair recently such as vascular and muscular tissue replacement and have high mechanical strength. — Christina Theodorou (clinical) [Ep 22 · 1:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=60)
- The study created 4 mm diaphragmatic defects in rats followed by immediate patch repair, with cohorts of six animals each plus a sham cohort of six rats. — Christina Theodorou (clinical) [Ep 22 · 1:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=60)
- Animals were survived for four weeks with fluoroscopic evaluation of diaphragmatic excursion at one and four weeks post-op. — Christina Theodorou (clinical) [Ep 22 · 1:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=60)
- No recurrences were seen in either the polyurethane or Gore-Tex cohort at four weeks. — Christina Theodorou (clinical) [Ep 22 · 2:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=120)
- At one week post-op, there was no difference in diaphragmatic excursion between sham, Gore-Tex, and polyurethane animals. — Christina Theodorou (clinical) [Ep 22 · 2:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=120)
- At four weeks, Gore-Tex had limited diaphragm rise compared to sham, but no difference was found between polyurethane and sham. — Christina Theodorou (clinical) [Ep 22 · 2:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=120)
- There were no differences in diaphragmatic excursion between polyurethane and Gore-Tex at any time point. — Christina Theodorou (clinical) [Ep 22 · 2:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=120)
- An inflammatory capsule was formed surrounding both polyurethane and Gore-Tex patches. — Christina Theodorou (clinical) [Ep 22 · 3:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=180)
- There was no significant difference in the size of the inflammatory capsule between the polyurethane and Gore-Tex cohorts. — Christina Theodorou (clinical) [Ep 22 · 3:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=180)
- The study had small numbers of animals in each cohort (six per group), likely under powering detection of significant differences. — Christina Theodorou (clinical) [Ep 22 · 3:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=180)
- Most diaphragmatic hernia recurrences occur at least a few months out from surgery, most commonly within the first two years. — Christina Theodorou (clinical) [Ep 22 · 3:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=180)
- The biodegradation rate of the polyurethane patch can be altered to match the rate of tissue in-growth with the goal of complete replacement over time with native diaphragm tissue. — Christina Theodorou (clinical) [Ep 22 · 3:00](https://team.globalcastmd.com/watch/bob-ped-surg-2023-christina-theodorou-caps-presentation-6346?t=180)
- A systematic review by the study group demonstrated that the incidence of CDH varies significantly between regions and populations with a global overall incidence of 2.3 per 10,000 births. — Adriana Degen (epidemiological) [Ep 33 · 1:30](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=90)
- There are no national Canadian epidemiological studies examining CDH prior to this study. — Adriana Degen (epidemiological) [Ep 33 · 1:45](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=105)
- The study utilized the Canadian Institute of Health Information discharge abstract database from 2006 to 2020 and Quebec's Med Echo database from 2008 to 2020. — Adriana Degen (clinical) [Ep 33 · 2:05](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=125)
- CDH cases were identified using the validated ICD-10 code Q79.0. — Adriana Degen (clinical) [Ep 33 · 2:30](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=150)
- The CIHI database included both live and stillbirths, whereas the Med Echo database only included live births. — Adriana Degen (clinical) [Ep 33 · 2:38](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=158)
- Terminations were excluded from both databases. — Adriana Degen (clinical) [Ep 33 · 2:48](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=168)
- There was no distinction between isolated versus complex CDH nor laterality in the databases. — Adriana Degen (clinical) [Ep 33 · 2:52](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=172)
- The Canadian incidence of CDH from 2006 to 2020 was 2.71 per 10,000 births. — Adriana Degen (epidemiological) [Ep 33 · 3:35](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=215)
- Manitoba had the highest incidence of CDH, followed by Nova Scotia and Saskatchewan. — Adriana Degen (epidemiological) [Ep 33 · 3:45](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=225)
- Manitoba had a significantly higher incidence of CDH compared to Ontario with an incidence rate ratio of 1.33. — Adriana Degen (epidemiological) [Ep 33 · 3:53](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=233)
- 58% of CDH patients were assigned male sex at birth. — Adriana Degen (epidemiological) [Ep 33 · 4:05](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=245)
- There was no significant difference in CDH incidence over time from 2006 to 2020. — Adriana Degen (epidemiological) [Ep 33 · 4:15](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=255)
- Advanced maternal age, specifically maternal age 40 plus, was associated with an increased rate of CDH with an incidence rate ratio of 1.68. — Adriana Degen (epidemiological) [Ep 33 · 4:25](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=265)
- The study was limited by use of aggregate versus patient level data, preventing control for various covariates and determination of independence of associations. — Adriana Degen (clinical) [Ep 33 · 4:40](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=280)
- Administrative data is limited in terms of what is collected and is subject to misclassification and imputation errors. — Adriana Degen (clinical) [Ep 33 · 4:52](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=292)
- This represents the first national study examining CDH incidence in Canada. — Adriana Degen (epidemiological) [Ep 33 · 5:02](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=302)
- Similar to other populations, male fetal sex and older maternal age are associated with an increased incidence of CDH. — Adriana Degen (epidemiological) [Ep 33 · 5:08](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=308)
- In Manitoba, there is not an overall increased maternal age according to Statistics Canada trends. — Adriana Degen (epidemiological) [Ep 33 · 6:20](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=380)
- The study group hypothesizes that there is an interplay between genetic, environmental, and sociodemographic influences affecting CDH incidence in Manitoba. — Adriana Degen (opinion) [Ep 33 · 6:35](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=395)
- A paper by Lou et al. found an increased incidence of gastroschisis in Manitoba, with northern regions of the province showing higher incidence. — Adriana Degen (epidemiological) [Ep 33 · 6:50](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=410)
- The elevated gastroschisis incidence in northern Manitoba is thought to be related to the communities that settle in northern regions, access to prenatal care, and prenatal exposures. — Adriana Degen (opinion) [Ep 33 · 7:08](https://team.globalcastmd.com/watch/dr-adriana-dekirmendjian-best-of-the-best-in-pediatric-surgery-2025-10040?t=428)
- Approximately 25% of CDH patients have concurrent cardiac anomalies. — Marietta Jank (epidemiological) [Ep 32 · 0:28](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=28)
- CITED2 is a transcriptional modulator that can be induced by hypoxia, interleukins, interferon gamma, TNF alpha and LPS. — Marietta Jank (clinical) [Ep 32 · 1:10](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=70)
- CITED2 binds with high affinity to coactivators regulating transactivation of multiple transcription factors including HIF-1 alpha, NF-kappa-B, PPAR gamma, and SMAD 2 and 3. — Marietta Jank (clinical) [Ep 32 · 1:30](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=90)
- CITED2 null mutant mice and rats are embryonic and perinatal lethal, or in the case of rats die within the first few hours after birth, exhibiting lung and cardiac anomalies. — Marietta Jank (clinical) [Ep 32 · 1:45](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=105)
- CITED2 is required for lung maturation and is detected in the septum transversum of the developing diaphragm. — Marietta Jank (clinical) [Ep 32 · 2:00](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=120)
- At embryonic day 15 in the nitrofen rat model, there was no difference in CITED2 expression between CDH and control lungs. — Marietta Jank (clinical) [Ep 32 · 2:40](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=160)
- At embryonic day 18, there was a decreased expression of CITED2 in nitrofen-induced CDH lungs, which was significant in in situ hybridization staining. — Marietta Jank (clinical) [Ep 32 · 2:55](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=175)
- At embryonic stage 21, there was an increased expression of CITED2 in both in situ hybridization and on QPCR level in nitrofen-induced lungs. — Marietta Jank (clinical) [Ep 32 · 3:10](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=190)
- Increased CITED2 staining was confirmed on a protein level in the epithelial layer of nitrofen-induced lungs. — Marietta Jank (clinical) [Ep 32 · 3:25](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=205)
- Human fetal CDH lungs at late gestation showed a significantly increased abundance of CITED2 compared to controls, similar to the nitrofen model pattern. — Marietta Jank (clinical) [Ep 32 · 4:00](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=240)
- Genomic sequencing of isolated CDH patients found a hotspot at the chromosomal coordinates for CITED2 on chromosome 6 compared to controls. — Marietta Jank (clinical) [Ep 32 · 4:15](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=255)
- Proteomic data showed altered inflammatory pathways at E21 nitrofen lungs with increased abundance of CBP, NF-kappa-B and STAT3, which are all interacting factors of CITED2. — Marietta Jank (clinical) [Ep 32 · 5:40](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=340)
- CITED2 may play a minor role in early lung development. — Marietta Jank (opinion) [Ep 32 · 4:40](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=280)
- At E18, CITED2 may promote pulmonary maturation. — Marietta Jank (opinion) [Ep 32 · 5:05](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=305)
- CITED2 orchestrates the inflammatory response in nitrofen-induced abnormal lung development at late gestation. — Marietta Jank (opinion) [Ep 32 · 5:25](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=325)
- CITED2 may be induced by NF-kappa-B signaling and acts as a negative feedback regulation of NF-kappa-B in the nucleus. — Marietta Jank (opinion) [Ep 32 · 5:55](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=355)
- The research team is collaborating with Kansas University for a CRISPR-Cas9 CITED2 mutant rat to investigate lung morphology throughout development. — Marietta Jank (clinical) [Ep 32 · 7:10](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=430)
- Lungs of babies with pulmonary hypoplasia secondary to congenital diaphragmatic hernia have an impaired triad of factors: impaired fetal lung growth, maturation, and vascularization. — Kasra Khalaj (clinical) [Ep 30 · 0:22](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=22)
- Prenatal therapies administered to treat pulmonary hypoplasia have not been able to fully rescue lung development. — Kasra Khalaj (clinical) [Ep 30 · 1:00](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=60)
- Extracellular vesicles are particles responsible for paracrine signaling. — Kasra Khalaj (clinical) [Ep 30 · 1:20](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=80)
- RAC1 is a Rho GTPase that modulates lung branching morphogenesis. — Kasra Khalaj (clinical) [Ep 30 · 2:20](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=140)
- RAC1 expression is down-regulated in CDH autopsy specimens compared to age-matched controls. — Kasra Khalaj (clinical) [Ep 30 · 2:40](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=160)
- Fetal lungs treated with RAC1 inhibitor display histological features resembling those of pulmonary hypoplasia. — Kasra Khalaj (clinical) [Ep 30 · 3:20](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=200)
- Human AFSCEVs restore airspace density with decreased parenchyma in hypoplastic fetal lungs. — Kasra Khalaj (clinical) [Ep 30 · 3:40](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=220)
- Human AFSCEVs restore branching morphogenesis marker FGF10 in hypoplastic fetal lungs. — Kasra Khalaj (clinical) [Ep 30 · 3:55](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=235)
- Human AFSCEVs restore key markers responsible for fetal lung maturation: surfactant protein C and podoplanin. — Kasra Khalaj (clinical) [Ep 30 · 4:05](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=245)
- Human AFSCEV-treated explants had reduced medial wall thickness and restored vascular density. — Kasra Khalaj (clinical) [Ep 30 · 4:20](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=260)
- A unique epithelial cell cluster termed 'stressed AT1/AT2' had high representation in hypoplastic lungs and was down-regulated after AFSCEV administration. — Kasra Khalaj (clinical) [Ep 30 · 4:45](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=285)
- The stressed AT1/AT2 cluster had up-regulated signaling pathways involved in cellular stress, death, and inflammation. — Kasra Khalaj (clinical) [Ep 30 · 5:00](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=300)
- A cluster termed 'developing AT1/AT2 cells' had the highest proportion in hypoplastic lungs treated with AFSCEVs and showed high TGF-beta and VEGF signaling. — Kasra Khalaj (clinical) [Ep 30 · 5:10](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=310)
- Human AFSCEV administration reduces the number of myofibroblasts in hypoplastic fetal lungs. — Kasra Khalaj (clinical) [Ep 30 · 5:25](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=325)
- Human AFSCEV administration restores vascular endothelial cluster nuclei numbers back to control levels. — Kasra Khalaj (clinical) [Ep 30 · 5:35](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=335)
- The restored vascular endothelial cluster had increased VEGF signaling, which is a primary pathway involved in angiogenesis. — Kasra Khalaj (clinical) [Ep 30 · 5:50](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=350)
- This is the first study to describe that human AFSCEV administration promotes the triad of fetal lung growth, maturation, and vascularization in fetal hypoplastic lungs. — Kasra Khalaj (clinical) [Ep 30 · 6:05](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=365)
- Investigators have tested various routes of AFSCEV administration including intratracheal and maternal IV in animal models. — Kasra Khalaj (clinical) [Ep 30 · 6:35](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=395)
- Intra-amniotic injection has shown promising results for AFSCEV administration. — Kasra Khalaj (clinical) [Ep 30 · 6:50](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=410)
- In the lamb CDH model, AFSCEVs are being administered in combination with fetal endoscopic tracheal occlusion (FETO). — Kasra Khalaj (clinical) [Ep 30 · 7:00](https://team.globalcastmd.com/watch/kasra-khalaj-msc-phd-best-of-the-best-in-pediatric-surgery-2024-8024?t=420)
- Organoids are an advanced in vitro system grown from tissue-specific stem cells that can be derived from fetal or adult tissues and used to study tissue biology and diseases. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Fetal organoids can be derived only after the termination of pregnancy when using traditional tissue-based methods. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Amniotic fluid is recirculated by different developing organs and contains stem cells. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- The first amniotic fluid cell atlas revealed that the majority of cells present in the fluid are epithelial at the single cell level. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Epithelial cells in amniotic fluid are shed from various developing organs including the gut, kidney, and lung. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Viable cells isolated from amniotic fluid can be cultured in 3D to form epithelial organoids of fetal origin that display different morphologies. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Gene expression profiling of amniotic fluid organoids shows they form three different groups: lung, kidney, and intestinal organoids. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Amniotic and tracheal fluid can be collected from CDH fetuses undergoing tracheal occlusion. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Lung organoids can be expanded from the fluid of CDH patients and contain lung epithelial stem progenitor cells. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- CDH organoids derived after fetal tracheal occlusion display fewer differentially expressed genes compared to those derived before the procedure, making them more similar to control organoids. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- The gene expression changes in CDH organoids indicate that fetal surgery is changing something at the molecular level, which is reflected in the organoid model. — Giuseppe Cala (opinion) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- CDH organoids appear to have impaired differentiation and function based on ciliary beating frequency measurements. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Single-cell RNA sequencing revealed that CDH organoids exhibit a very different cell type composition when compared to healthy controls. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Amniotic fluid contains fetal epithelial stem cells that can form organoids in culture, and these organoids can be generated during pregnancy without using tissue samples. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Lung organoids can be derived prenatally from the fluids of CDH fetuses. — Giuseppe Cala (clinical) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- This organoid technology may serve in the future as a tool for functional prenatal diagnosis and clinical decision making. — Giuseppe Cala (opinion) [Ep 29 · 0:20](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=20)
- Fetal organoids can be used to study development because it is difficult to access fetal tissue, providing a different tool to study the epithelium of fetuses. — Giuseppe Cala (opinion) [Ep 29 · 4:56](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=296)
- Organoids can be used to test both known compounds already working in clinics and new compounds, with the outcome of organoid phenotype after treatment correlated with patient clinical outcomes. — Giuseppe Cala (clinical) [Ep 29 · 4:56](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=296)
- For the CDH organoid system, the translational potential is in drug testing rather than transplantation. — Giuseppe Cala (opinion) [Ep 29 · 4:56](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=296)
- A drug testing platform is being established to test as many drugs as possible on CDH organoids, with interest in drugs that enhance proliferation of epithelial cells. — Giuseppe Cala (clinical) [Ep 29 · 6:22](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=382)
- In CDH, the lungs are hypoplastic, and drugs could potentially improve lung maturation by testing on organoids. — Giuseppe Cala (clinical) [Ep 29 · 6:22](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=382)
- Drugs tested on organoids could potentially be implemented with the endoluminal tracheal occlusion procedure, similar to how nanoparticles could be implemented. — Giuseppe Cala (opinion) [Ep 29 · 6:22](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=382)
- A patent is ongoing for the organoid technology but the organoids are not yet commercially available. — Giuseppe Cala (clinical) [Ep 29 · 7:13](https://team.globalcastmd.com/watch/giussepe-cala-phd-candidate-best-of-the-best-in-pediatric-surgery-2024-8017?t=433)
- CDH patients present with a hole in the diaphragm and abnormal lung development resulting in lung hypoplasia and persistent pulmonary hypertension — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- The incidence of CDH is 1 in 2000 to 5000 live births — Yuichiro Miyake (epidemiological) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- About 150 CDH babies are born every day in the world — Yuichiro Miyake (epidemiological) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- About 50 CDH babies die every day — Yuichiro Miyake (epidemiological) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Fetoscopic endoluminal tracheal occlusion (FETO) is currently performed to increase survival rate of CDH babies — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- In a randomized controlled trial, FETO improved the survival rate for severe CDH from 15% to 40% — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Chitosan nanoparticles possess the ability to encapsulate various therapeutic substances — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Combining FETO with nanoparticle-based drug delivery could potentially lead to better outcomes for CDH babies — Yuichiro Miyake (opinion) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- A microinjector was designed based on a microinsemination device to investigate combination of FETO with drug administration — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Rat fetuses were removed on embryonic day 18 for the lung explant model — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Nanoparticles were injected into the trachea and the trachea was tied with surgical suture to replicate the FETO model — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- An IgG antibody selected to target pulmonary tissue was used to functionalize the nanoparticles — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- IgG nanoparticles exhibited superior uptake into the lungs compared to bare nanoparticles — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- The relative number of nanoparticles to DAPI was about 2.5-fold higher in the IgG nanoparticles group compared to bare nanoparticles — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Active caspase-3 protein abundance was not significantly different among control, bare nanoparticles, and IgG nanoparticles groups — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- IL-6 protein abundance was not significantly different among control, bare nanoparticles, and IgG nanoparticles groups — Yuichiro Miyake (clinical) [Ep 28 · 0:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=21)
- Lungs were dissected from rat pups, nanoparticles injected, trachea tied, and cultured for 2-3 days before analysis — Yuichiro Miyake (clinical) [Ep 28 · 5:44](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=344)
- The next step involves encapsulating therapeutic agents in chitosan nanoparticles and testing whether they improve lung development in the explant model — Yuichiro Miyake (opinion) [Ep 28 · 6:21](https://team.globalcastmd.com/watch/yuichiro-miyake-md-best-of-the-best-in-pediatric-surgery-2024-8010?t=381)
- Synthetic patches such as PTFE or Gore-Tex used for large diaphragmatic defects are associated with significant morbidity, including hernia recurrence, bowel obstructions, and chest wall deformities as the child grows. — Christina Theodorou (clinical) [Ep 19 · 3:53](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=233)
- Biodegradable forms of polyurethane have been used in tissue repair recently, such as vascular and muscular tissue replacement, and have high mechanical strength. — Christina Theodorou (clinical) [Ep 19 · 4:40](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=280)
- In the rat model study, 4mm diaphragmatic defects were created followed by immediate patch repair, with six animals in each cohort plus a sham cohort of six rats. — Christina Theodorou (clinical) [Ep 19 · 5:10](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=310)
- No recurrences were seen in either the polyurethane or Gore-Tex cohort at four weeks. — Christina Theodorou (clinical) [Ep 19 · 6:00](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=360)
- At one week, there was no difference in diaphragmatic excursion between sham, Gore-Tex and polyurethane animals. — Christina Theodorou (clinical) [Ep 19 · 6:10](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=370)
- At four weeks, Gore-Tex had limited diaphragm rise compared to sham, but no difference was found between polyurethane and sham. — Christina Theodorou (clinical) [Ep 19 · 6:20](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=380)
- There were no differences in diaphragmatic excursion between polyurethane and Gore-Tex at any time point. — Christina Theodorou (clinical) [Ep 19 · 6:35](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=395)
- An inflammatory capsule was formed surrounding both patches, with no significant difference in the size of that inflammatory capsule between the cohorts. — Christina Theodorou (clinical) [Ep 19 · 6:45](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=405)
- The study had small numbers of animals in each cohort, likely underpowering detection of significant differences. — Christina Theodorou (clinical) [Ep 19 · 7:10](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=430)
- Most recurrences of diaphragmatic hernia occur at least a few months out from surgery, most commonly within the first two years. — Christina Theodorou (clinical) [Ep 19 · 7:20](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=440)
- The biodegradation rate of the polyurethane patch cannot be too fast because then there will be another hernia. — Tony (clinical) [Ep 19 · 8:03](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=483)
- Understanding the intrinsic strength of the polyurethane patch at different time periods will be really important for its use as a diaphragm patch. — Tony (opinion) [Ep 19 · 8:03](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=483)
- There is some evidence that absorbable patches are not as good and the recurrence rate is higher for diaphragmatic hernias compared to non-absorbable patches. (clinical) [Ep 19 · 8:25](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=505)
- Tony personally uses a Gore-Tex patch that stays there forever and gets embedded into the tissues because of the high incidence of recurrent hernias with biodegradable patches. — Tony (opinion) [Ep 19 · 8:43](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=523)
- A short-term study showing that the polyurethane patch works is not adequate evidence to translate it to patient care. — Tony (opinion) [Ep 19 · 10:20](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-caps-winner-christina-theodorou-md-6327?t=620)
- Fetal lung vascular remodeling predisposes fetuses with CDH to postnatal pulmonary hypertension, which plays a central role in the poor outcomes of these babies. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- The prenatal period offers a window of opportunity to promote normal lung development in CDH. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- No antenatal treatments tested to date have been successful in fully rescuing normal lung development in CDH. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- AFSEVs promote growth and maturation in fetal hypoplastic lungs via the release of RNA cargo. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Vascular density was rescued back to normal levels after AFSEV administration in rat CDH lungs. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Vascular remodeling was attenuated in CDH treated lungs after AFSEV administration. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Angiogenic factors were rescued back to normal levels after AFSEV treatment in rat CDH lungs. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- AFSEVs attenuated the severity of right ventricular hypertrophy in CDH hearts. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Vascular density was restored by AFSEV treatment in human fetal lung explant model of pulmonary hypoplasia. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Vascular remodeling was attenuated in hypoplastic treated human fetal lungs after AFSEV administration. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Angiogenic factors were rescued back to normal levels after AFSEV treatment in human fetal hypoplastic lungs. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Single nucleus RNA sequencing revealed a striking difference between control and CDH in the pattern and distribution of endothelial cells, which was rescued to normal distribution following AFSEV treatment. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- 245 differentially expressed genes that regulate vasculogenesis and angiogenesis were down-regulated in CDH lungs and up-regulated in CDH treated lungs. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- AFSEV cargo contains microRNAs that control processes like angiogenesis and proliferation and migration of vascular endothelial cells. — Rebecca Figueira (clinical) [Ep 18 · 2:22](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=142)
- Ongoing studies in large animals are being conducted to determine the right dose, route, and whether multiple administrations are needed for AFSEV treatment. — Rebecca Figueira (clinical) [Ep 18 · 8:46](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=526)
- AFSEVs themselves are less immunogenic than isolated microRNAs and deliver the whole cargo, not only the microRNAs. — Rebecca Figueira (clinical) [Ep 18 · 8:46](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=526)
- AFSEVs administered to the mother intravenously can reach the fetal lungs. — Rebecca Figueira (clinical) [Ep 18 · 8:46](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=526)
- Fetal lung vascular remodeling predisposes fetuses with CDH to postnatal pulmonary hypertension, which plays a central role in the poor outcomes of these babies. — Rebeca Figueira (clinical) [Ep 20 · 0:00](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=0)
- There is consensus that the prenatal period offers a window of opportunity to promote normal lung development in CDH. — Rebeca Figueira (guideline) [Ep 20 · 0:30](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=30)
- No antenatal treatments tested to date have been successful in CDH. — Rebeca Figueira (clinical) [Ep 20 · 1:00](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=60)
- AFSCVs promote growth and maturation in fetal hypoplastic lungs via the release of RNA cargo. — Rebeca Figueira (clinical) [Ep 20 · 1:20](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=80)
- EVs were isolated using ultracentrifugation and characterized in accordance with the International Society of Extracellular Vesicles guidelines. — Rebeca Figueira (clinical) [Ep 20 · 3:00](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=180)
- A nitrophen model of CDH in rats was used with antenatal AFSCV injection into the amniotic sac at E18. — Rebeca Figueira (clinical) [Ep 20 · 3:30](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=210)
- Vascular density was rescued back to normal levels after AFSCV administration in rat CDH lungs. — Rebeca Figueira (clinical) [Ep 20 · 5:00](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=300)
- Vascular remodeling was attenuated in CDH treated lungs. — Rebeca Figueira (clinical) [Ep 20 · 5:30](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=330)
- Angiogenic factors were rescued back to normal levels after AFSCV treatment in rat lungs. — Rebeca Figueira (clinical) [Ep 20 · 5:50](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=350)
- AFSCVs attenuated the severity of right ventricular hypertrophy in CDH hearts. — Rebeca Figueira (clinical) [Ep 20 · 6:20](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=380)
- The Fulton index expresses the degree of right ventricular hypertrophy and is an indirect marker of pulmonary hypertension. — Rebeca Figueira (clinical) [Ep 20 · 4:30](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=270)
- Vascular density was restored by AFSCV treatment in human fetal lung explants with hypoplasia. — Rebeca Figueira (clinical) [Ep 20 · 8:30](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=510)
- Vascular remodeling was attenuated in hypoplastic treated human lung explants. — Rebeca Figueira (clinical) [Ep 20 · 9:00](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=540)
- Angiogenic factors were rescued back to normal levels after AFSCV treatment in human lung explants. — Rebeca Figueira (clinical) [Ep 20 · 9:20](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=560)
- Single nucleus RNA sequencing revealed a striking difference between control and CDH in the pattern and distribution of endothelial cells, which was rescued to normal distribution following AFSCV treatment. — Rebeca Figueira (clinical) [Ep 20 · 10:20](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=620)
- 245 differentially expressed genes were identified in endothelial cells. — Rebeca Figueira (clinical) [Ep 20 · 11:00](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=660)
- Genes regulating vasculogenesis and angiogenesis were downregulated in CDH lungs and upregulated in CDH treated lungs. — Rebeca Figueira (clinical) [Ep 20 · 11:20](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=680)
- AFSCV cargo contains microRNAs that control processes like angiogenesis and proliferation and migration of vascular endothelial cells. — Rebeca Figueira (clinical) [Ep 20 · 11:50](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=710)
- AFSCVs rescue vascular development and attenuate vascular remodeling in rat and human fetal hypoplastic lungs. — Rebeca Figueira (clinical) [Ep 20 · 12:20](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=740)
- AFSCVs modulate angiogenic processes and rescue the expression of genes involved in lung vascular development. — Rebeca Figueira (clinical) [Ep 20 · 12:40](https://team.globalcastmd.com/watch/bob-winner-presentation-dr-rebeca-figueira-eupsa-6339?t=760)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A Columbia paper showed high recurrence rates with MIS CDH repair, creating resistance to the approach — Wolfan summarizing the discussion [Ep 1 · 1:11](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=71)
- Charlie Stoller showed approximately 30% recurrence rate with thoracoscopic CDH repair — Ron summarizing the discussion [Ep 1 · 6:36](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=396)
- Using buttress material reduces recurrence rates in CDH repair, per data from Rusty and Craig's institution — Wolfan summarizing the discussion [Ep 1 · 12:31](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=751)
- A recent Pediatric Surgery International paper showed low rates of return to ECMO and death following CDH repair, not justifying routine repair on ECMO — Wolfan summarizing the discussion [Ep 1 · 29:43](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1783)
- Timing of CDH repair has no real influence on ultimate survival — Wolfan summarizing the discussion [Ep 1 · 30:08](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1808)
- David Kays in Saint Petersburg achieves 100% survival in CDH (last 75 patients, all comers including preemies and heart disease), with 80% requiring ECMO and all repaired immediately on ECMO — The host summarizing the discussion [Ep 1 · 31:19](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1879)
- David Kays switched to using bivalirudin for ECMO anticoagulation and reports decreased bleeding rates with immediate CDH repair on ECMO — Ron summarizing the discussion [Ep 1 · 32:34](https://team.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1954)
- Gastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time. — Rod Gerardo summarizing the discussion [Ep 15 · 1:18](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=78)
- Gastric volvulus is associated with eventration of the diaphragm about 25% of the time. — Rod Gerardo summarizing the discussion [Ep 15 · 1:18](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=78)
- Acute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia. — Rod Gerardo summarizing the discussion [Ep 15 · 2:13](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=133)
- Without ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points. — Rod Gerardo summarizing the discussion [Ep 15 · 3:27](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=207)
- Gastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube. — Rod Gerardo summarizing the discussion [Ep 15 · 4:58](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=298)
- On upper GI contrast study in gastric volvulus, contrast probably does not go past the stomach if it makes it into the stomach. — Ellen Encisco summarizing the discussion [Ep 15 · 5:32](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=332)
- A classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus. — Rod Gerardo summarizing the discussion [Ep 15 · 5:41](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=341)
- In organoaxial volvulus, if contrast gets past the GE junction into the stomach, the greater curvature appears flipped up. — Ellen Encisco summarizing the discussion [Ep 15 · 5:53](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=353)
- Gastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization. — Rod Gerardo summarizing the discussion [Ep 15 · 7:34](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=454)
- Fundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases. — Rod Gerardo summarizing the discussion [Ep 15 · 7:47](https://team.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=467)
- External validation from Children's Hospital Philadelphia (2006-2010 cohort) and Toronto confirmed that outcomes remain dependent on lung-to-head ratio and these selection criteria are still valid. — Jan Deprest summarizing the discussion [Ep 7 · 2:36](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=156)
- Amnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow. — Todd Ponsky summarizing the discussion [Ep 7 · 90:22](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5422)
- Huber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction. — Todd Ponsky summarizing the discussion [Ep 7 · 102:07](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6127)
- High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks. — Todd Ponsky summarizing the discussion [Ep 7 · 103:26](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6206)
- Major and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser. — Todd Ponsky summarizing the discussion [Ep 7 · 104:15](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6255)
- Eduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin). — Todd Ponsky summarizes what Dr. Eduardo Gratacos said [Ep 7 · 128:56](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7736)
- Type 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions. — Todd Ponsky summarizing the discussion [Ep 7 · 131:00](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7860)
- With purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin. — Todd Ponsky summarizing the discussion [Ep 7 · 136:04](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8164)
- Type 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups. — Todd Ponsky summarizing the discussion [Ep 7 · 136:36](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8196)
- The CDH study group collected patient data from 2015 to 2018 in a retrospective review of prospectively collected data examining cardiac dysfunction within the first 48 hours of life. — Vic summarizing the discussion [Ep 9 · 4:31](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=271)
- Among all CDH patients in the study period, 39% had some evidence of cardiac dysfunction on their first echocardiogram in the first 48 hours of life. — Vic summarizing the discussion [Ep 9 · 5:19](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=319)
- Patients with normal cardiac function had a survival of over 80% on adjusted analysis. — Vic summarizing the discussion [Ep 9 · 5:36](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=336)
- Patients with right ventricular dysfunction only had a survival of 74%. — Vic summarizing the discussion [Ep 9 · 5:42](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=342)
- Patients with left ventricular dysfunction had a survival of 57%. — Vic summarizing the discussion [Ep 9 · 5:46](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=346)
- Patients with biventricular dysfunction had a survival of 50%, the worst risk profile. — Vic summarizing the discussion [Ep 9 · 5:50](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=350)
- Even when adjusting for liver position, defect size, and other important variables, cardiac dysfunction was still a significant driver of mortality in CDH. — Vic summarizing the discussion [Ep 9 · 6:01](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=361)
- The standardized post-operative protocol for Nuss pectus repair included scheduled anti-emetics, epidural pain control discontinued on post-op day 2, early Foley removal, and encouraged ambulation. — Joe L'Huillier summarizing the discussion [Ep 9 · 11:31](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=691)
- The standardized protocol decreased length of stay following Nuss pectus repair from 4.4 days to 3.4 days. — Joe L'Huillier summarizing the discussion [Ep 9 · 12:06](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=726)
- There were zero readmissions out of 164 patients in the Nuss pectus repair standardization study. — Joe L'Huillier summarizing the discussion [Ep 9 · 12:15](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=735)
- The Cincinnati Children's pectus protocol did not use cryotherapy for pain control in any patients. — Joe L'Huillier summarizing the discussion [Ep 9 · 13:57](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=837)
- The Cincinnati authors acknowledged studies showing cryo versus epidurals showed no difference in pain control but decreased length of stay with cryotherapy, yet expressed reservations due to lack of long-term outcomes data. — Joe L'Huillier summarizing the discussion [Ep 9 · 14:29](https://team.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=869)
- Ultrasound is usually the screening tool to find congenital diaphragmatic hernia in the fetus. — Rod Gerardo summarizes what Dr. Fung Lim said [Ep 10 · 1:40](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=100)
- MRI provides higher resolution imaging than ultrasound and yields information about the pulmonary status of the fetus in CDH. — Rod Gerardo summarizes what Dr. Fung Lim said [Ep 10 · 1:48](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=108)
- Fetuses with severe CDH (liver herniation and bilateral lung hypoplasia) are good candidates for FETO. — Rod Gerardo summarizes what Dr. Fung Lim said [Ep 10 · 2:35](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=155)
- Fetal lung tissue constantly creates fluid that normally escapes through the trachea; occluding the trachea causes fluid and pressure to build up, which helps the lungs develop. — Rod Gerardo summarizes what Dr. Fung Lim said [Ep 10 · 3:48](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=228)
- The balloon is typically removed at about 34 weeks gestation. — Rod Gerardo summarizes what Dr. Fung Lim said [Ep 10 · 4:18](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=258)
- Meta-analysis by Shibuya et al. included 709 patients from 15 research studies across multiple international centers comparing thoracoscopic versus open repair for congenital diaphragmatic hernia. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 35 · 1:03](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=63)
- Thoracoscopic repair for congenital diaphragmatic hernia has higher recurrence rates compared to open repair. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 35 · 1:18](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78)
- Thoracoscopic repair for congenital diaphragmatic hernia has longer operative times compared to open repair. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 35 · 1:18](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78)
- Thoracoscopic repair for congenital diaphragmatic hernia has a lower incidence of postoperative bowel obstruction compared to open repair. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 35 · 1:25](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=85)
- Ziegler et al. prospective study included 10 patients with giant omphalocele and 6 with complicated gastroschisis using a traction-assisted abdominal wall closure device (Fascia Tense Pediatric). — Alex Halpern summarizing a resource [Ep 35 · 1:58](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=118)
- Complete fascial closure was achieved after a median of 7 days in children with giant omphalocele using the Fascia Tense Pediatric device. — Alex Halpern summarizing a resource [Ep 35 · 2:13](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133)
- Complete fascial closure was achieved after a median of 5 days in children with complicated gastroschisis using the Fascia Tense Pediatric device. — Alex Halpern summarizing a resource [Ep 35 · 2:13](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133)
- No patients developed abdominal compartment syndrome after traction-assisted closure with Fascia Tense Pediatric. — Alex Halpern summarizing a resource [Ep 35 · 2:23](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143)
- No ventral hernias occurred after a median follow-up of 12 months in patients who underwent traction-assisted closure with Fascia Tense Pediatric. — Alex Halpern summarizing a resource [Ep 35 · 2:23](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143)
- Esposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two). — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 35 · 3:01](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=181)
- Laparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 35 · 3:23](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- Laparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 35 · 3:23](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- Laparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 35 · 3:23](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- Laparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 35 · 3:38](https://team.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=218)
- At Cincinnati Children's, interventional radiologists teach pediatric surgery fellows how to use ultrasound guidance for vascular access. — The host summarizing the discussion [Ep 34 · 0:53](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53)
- You don't have to have a hybrid OR to do image-guided surgery collaboration; it can occur in a regular OR by bringing in an ultrasound machine. — The host summarizing the discussion [Ep 34 · 1:02](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62)
- ChatGPT can screen thousands of articles in systematic reviews by analyzing Excel sheets and screening included articles based on title and abstract. — The host summarizing the discussion [Ep 34 · 2:20](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140)
- In cryoanalgesia for pectus procedures, a double lumen endotracheal tube is used in all patients to deflate the lung on the side of cryoablation. — The host summarizing the discussion [Ep 34 · 4:35](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275)
- Cryoanalgesia targets nerves from T3 to T8 with a 2-minute freeze cycle starting at the third rib and working down. — The host summarizing the discussion [Ep 34 · 4:46](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286)
- Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with cryo nerve block. — The host summarizing the discussion [Ep 34 · 4:56](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296)
- Cryoanalgesia blocks fail when surgeons use a single lumen tube and perform the block too far anteriorly. — The host summarizing the discussion [Ep 34 · 5:13](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313)
- The SER Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed survival was equivalent between groups. — The host summarizing the discussion [Ep 34 · 6:43](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403)
- Every unilateral isolated CDH should be pursued with ECMO if there was good prenatal counseling with the parents. — The host summarizing the discussion [Ep 34 · 6:58](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=418)
- With bivalrudin, you can operate after 8 hours of putting patients on ECMO as long as levels are stable, and it's a much easier surgical repair. — The host summarizing the discussion [Ep 34 · 7:26](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446)
- Early repair while on ECMO is safe and can offer physiological benefits, with the optimal window between 8 to 24 hours. — The host summarizing the discussion [Ep 34 · 7:41](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=461)
- CO2 laser emits infrared light in the spectrum of 920 to 1400 nanometers, which is well absorbed by water. — The host summarizing the discussion [Ep 34 · 8:14](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494)
- In 56 circumcision cases using CO2 laser with the sleeve technique, dorsal slit, and cyanoacrylate adhesive, the complication rate was only 3%. — The host summarizing the discussion [Ep 34 · 8:30](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510)
- CO2 laser was used for frenulectomy in 47 patients with low pain profile and no suture required. — The host summarizing the discussion [Ep 34 · 8:40](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520)
- Autofluorescence has shown to reduce rates of hypoparathyroidism and hypocalcemia following thyroidectomy in a randomized controlled trial from France. — The host summarizing the discussion [Ep 34 · 9:37](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577)
- With a surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%. — The host summarizing the discussion [Ep 34 · 12:14](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734)
- MMP-7 was identified about 10 years ago by Georgia Bezarra as a diagnostic biomarker for biliary atresia. — The host summarizing the discussion [Ep 34 · 13:07](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=787)
- Data from a recent Midwest study shows that every 10-day delay in biliary atresia treatment worsens outcomes by 20%. — The host summarizing the discussion [Ep 34 · 13:41](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821)
- MMP-7 is not a validated biomarker for biliary atresia; it's not perfect, and the sensitivity is pretty good, but cutoffs vary because the assay is still evolving. — The host summarizing the discussion [Ep 34 · 13:58](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838)
- The institutional commitment is to perform Kasai procedure within 7 days of patients showing up if they have biliary atresia. — The host summarizing the discussion [Ep 34 · 14:15](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=855)
- REBOA can be used in children if you have it at your center and you're good at it, though it's not done a lot in pediatric hospitals. — The host summarizing the discussion [Ep 34 · 15:08](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=908)
- REBOA seems to take longer than opening the abdomen or chest if you're just needing to cross-clamp the aorta. — The host summarizing the discussion [Ep 34 · 15:48](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948)
- Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always get to the finish line fully healed with a minimally invasive approach. — The host summarizing the discussion [Ep 34 · 16:23](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983)
- John Armstrong, while serving in the US Army, ran a clinic where patients were shaved weekly, and they observed a dramatic improvement, significantly reducing the need for surgical intervention in pilonidal disease. — The host summarizing the discussion [Ep 34 · 16:40](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000)
- If you're not pushing hair removal and meticulous hygiene, you're probably going to end up operating on some people that might not need an operation for pilonidal disease. — The host summarizing the discussion [Ep 34 · 16:55](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1015)
- For pilonidal disease hair removal, if there's a parent or active caregiver involved, clipping is probably the easiest and simplest approach, with once-a-week recommended. — The host summarizing the discussion [Ep 34 · 17:17](https://team.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037)
- The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 40 · 0:47](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=47)
- FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 40 · 0:53](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=53)
- The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 40 · 3:08](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=188)
- Sometimes the trocar advances into the mouth during the procedure and needs to be backed out. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 40 · 3:33](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=213)
- Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 40 · 3:40](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=220)
- The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 41 · 0:47](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=47)
- FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 41 · 0:53](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=53)
- The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 41 · 3:08](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=188)
- After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 41 · 3:40](https://team.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=220)
- Most centers wait to repair CDH until right-sided (pulmonary) pressures are lower than systemic pressures. — The host summarizing the discussion [Ep 2 · 1:00](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=60)
- Early studies from Babies Hospital showed relatively high recurrence rate for primary MIS CDH repair, but this may be related to technique. — The host summarizing the discussion [Ep 2 · 2:30](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=150)
- Recent study suggests waiting until after ECMO decannulation for CDH repair may improve survival rates. — The host summarizing the discussion [Ep 2 · 1:30](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=90)
- VV ECMO overall outcomes may favor VV over VA ECMO for CDH; VA ECMO associated with more neurologic events, VV with more renal complications. — The host summarizing the discussion [Ep 2 · 25:42](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1542)
- Propensity analysis showed VV ECMO survival 60% versus VA ECMO 46% for CDH. — The host summarizing the discussion [Ep 2 · 26:20](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1580)
- Oxygen is an incredible inotrope; oxygenated blood via VV ECMO often allows weaning of pressors. — The host summarizing the discussion [Ep 2 · 28:32](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1712)
- ELSO registry study of matched patients showed higher survival for CDH repair after ECMO versus on ECMO. — The host summarizing the discussion [Ep 2 · 35:51](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2151)
- Muscle flap repair (transversus abdominis) has dramatically lower recurrence rate than patch repair for large CDH defects, particularly in ECMO population. — The host summarizing the discussion [Ep 2 · 33:10](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1990)
- Consensus among audience: wait 2-4 days before repairing stable term CDH neonate to ensure pulmonary hypertension does not develop. — The host summarizing the discussion [Ep 2 · 16:32](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=992)
- Audience poll: 63% would perform thoracoscopic patch repair, 60% would do MIS repair after ECMO, 67% prefer thoracoscopic approach overall. — Todd Ponsky summarizing the discussion [Ep 2 · 20:03](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1203)
- Standard ECMO criteria require repeated evidence of elevated OI over several hours, not single measurement. — The host summarizing the discussion [Ep 2 · 22:30](https://team.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1350)
- The study evaluated autophagy in hypoplastic lungs throughout gestation and established whether extracellular vesicles from rat and human amniotic fluid stem cells can improve branching morphogenesis through autophagy-mediated mechanisms including microRNA cargo transfer — The host summarizing the discussion [Ep 13 · 5:56](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=356)
- The study demonstrated that autophagy levels are deregulated in fetal hypoplastic lungs from rats and humans — The host summarizing the discussion [Ep 13 · 6:47](https://team.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=407)
- Protocol changes began in August 2023 and were implemented in spring of 2024 — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 0:20](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=20)
- Previously, peak pressures were limited to 25 to 26 cmH2O and mean airway pressures to less than 16 to 17 cmH2O — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 1:26](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=86)
- Previously, babies were fed once they had return of bowel function after repair — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 2:12](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=132)
- Previously, babies received as-needed sedation — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 2:44](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=164)
- The new cohort had 36 babies compared to 99 in the previous cohort — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 3:31](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=211)
- ECMO use increased from 14% to 22% in the new cohort — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 3:31](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=211)
- Survival for ECMO patients increased from 39% to 55% — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 4:09](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=249)
- ECMO use was around 41% in the old cohort versus 45% in the new cohort — Jill Knepprath summarizes what Dr. Paul Kingma said [Ep 39 · 4:29](https://team.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=269)
- Data from Utah and other centers suggest recurrence rate is dramatically lower with muscle flap repair compared to patch repair for CDH. — The host summarizing the discussion [Ep 4 · 0:41](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=41)
- Ted Brand at the speaker's other hospital reported 0% recurrence rate with muscle flap CDH repairs. — The host summarizing the discussion [Ep 4 · 1:22](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=82)
- Some surgeons with good outcomes have data showing higher recurrence rates with MIS CDH repair. — The host summarizing the discussion [Ep 4 · 4:00](https://team.globalcastmd.com/watch/cdh-mis-vs-open-update-course-2015-998?t=240)
- There is evidence that the complication rate with VA ECMO is higher than VV ECMO — Todd Ponsky summarizing the discussion [Ep 5 · 1:22](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=82)
- VA ECMO is associated with more neurological complications compared to VV ECMO — The host summarizing the discussion [Ep 5 · 5:31](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- VV ECMO is associated with more renal complications compared to VA ECMO — The host summarizing the discussion [Ep 5 · 5:31](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- In the ELSO registry for CDH, VA ECMO had 48% survival and VV ECMO had 43% survival, with no statistically significant difference — The host summarizing the discussion [Ep 5 · 5:31](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- A propensity-matched analysis of the ELSO registry showed a survival advantage for VV ECMO over VA ECMO in CDH patients — The host summarizing the discussion [Ep 5 · 5:31](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- There is some data suggesting VV ECMO is probably advantageous over VA ECMO — Todd Ponsky summarizing the discussion [Ep 5 · 6:34](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=394)
- Data from Texas Children's Group shows that early repair on ECMO versus off ECMO does not have statistically significant difference in outcomes, though curves suggest a tendency favoring post-ECMO repair — The host summarizing the discussion [Ep 5 · 8:43](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=523)
- After ECMO, most people will do open CDH repair — Todd Ponsky summarizing the discussion [Ep 5 · 9:27](https://team.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=567)
- Prior data shows higher rates of anxiety and depression in mothers with prenatal fetal anomaly diagnoses — Nina Bentz summarizing the discussion [Ep 16 · 14:32](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=872)
- Data from the trauma literature shows no clear correlation between disease or injury severity and development of PTSD — Nina Bentz summarizing the discussion [Ep 16 · 18:20](https://team.globalcastmd.com/watch/ifmss-2019-clinical-studies-6109?t=1100)
- Existing studies show that black race is an independent risk factor for mortality in CDH and is further compounded by low socioeconomic status — Shelby Sferra summarizing the discussion [Ep 17 · 3:50](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=230)
- Studies show that patient-physician concordance in race and ethnicity improves outcomes for minority patient populations — Shelby Sferra summarizing the discussion [Ep 17 · 9:50](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=590)
- Patient-physician concordance has been shown to improve outcomes and survival in CDH cases — Shelby Sferra summarizing the discussion [Ep 17 · 10:05](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-aap-winner-shelby-sferra-md-6321?t=605)
- Existing studies on disparities in CDH show that Black race is an independent risk factor for mortality and is further compounded by low socioeconomic status. — Shelby Sferra summarizing a resource [Ep 21 · 0:45](https://team.globalcastmd.com/watch/bob-ped-surg-2023-shelby-sferra-aap-presentation-6345?t=45)
- FETO (fetal endoscopic tracheal occlusion) shows higher general survival in severe CDH compared to no FETO, based on 4 randomized controlled trials with 341 patients total — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 2:43](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=163)
- For severe CDH, referral to a center that performs FETO should be considered to evaluate if it would increase the baby's chance of survival — Jose Campos summarizes what Dr. Fernando Bullettin said [Ep 24 · 4:31](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=271)
- For on-ECMO CDH repair, anticoagulation is managed by decreasing heparin and using Amicar before, during, and after surgery — Todd Ponsky summarizes what Dr. Fernando Bullettin said [Ep 24 · 5:37](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=337)
- Boston Children's Hospital retrospective study found on-ECMO repair group had lower mortality rate, lower hazard ratio, and lower incidence of non-repair compared to after-ECMO repair — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 6:10](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=370)
- Early repair on ECMO was associated with lower mortality rate, hazard ratio, and lower incidence of non-repair compared to late repair on ECMO — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 6:10](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=370)
- 2014 Canadian meta-analysis found MIS approach has higher rates of recurrence (especially with patch) and longer operative time compared to open repair — Jose Campos summarizes what Dr. Fernando Bullettin said [Ep 24 · 8:26](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=506)
- Open repair was associated with more postoperative ventilator time and higher mortality rates in the meta-analysis — Jose Campos summarizes what Dr. Fernando Bullettin said [Ep 24 · 8:26](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=506)
- University of Colorado retrospective study (52 patients, 2008-2018) found patients with flap repair have lower risk of recurrence compared to patch repair — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 11:41](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=701)
- Lower recurrence with flap repair might be due to the flap's ability to grow over time with the child — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 11:41](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=701)
- UK systematic review and meta-analysis (986 patients: 226 biological, 760 synthetic) found biological patches had 30.3% recurrence rate versus 16.7% for synthetic patches — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 13:21](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=801)
- Biological patches had adhesion rates of 7-35% and synthetic patches 4-29% in the UK meta-analysis — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 13:21](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=801)
- Synthetic patches were associated with 80% chest wall deformity rate in the UK meta-analysis — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 13:21](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=801)
- The UK meta-analysis had heterogeneity due to different synthetic meshes, different biological meshes, and different fixation techniques that were not accounted for — Jose Campos summarizes what Dr. Fernando Bullettin said [Ep 24 · 14:51](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=891)
- French prospective cohort study (762 CDH neonates, 81 underwent fundoplication) found preventive fundoplication during patch repair does not decrease the need for curative fundoplication and is associated with adverse GI outcomes — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 15:44](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=944)
- The decision to perform fundoplication at time of CDH repair is based on knowing from the defect type that fundoplication will eventually be needed in a baby who just had very difficult surgery — Todd Ponsky summarizes what Dr. Fernando Bullettin said [Ep 24 · 16:36](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=996)
- Prophylactic fundoplication was associated with 81% failure-to-thrive rate versus 51% without fundoplication in the French study — Cecilia Gigena summarizes what Dr. Fernando Bullettin said [Ep 24 · 16:58](https://team.globalcastmd.com/watch/case-based-journal-review-congenital-diaphragmatic-hernia-2023-7336?t=1018)
- The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 42 · 0:47](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=47)
- FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 42 · 0:53](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=53)
- The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 42 · 3:08](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=188)
- After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 42 · 3:40](https://team.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-procedure-step-by-step-guide-with-dr-beth-rymeski-14010?t=220)
- FETO (fetoscopic endotracheal occlusion) uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it, trapping fluid in the lungs to allow expansion and growth. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 44 · 0:17](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=17)
- Liver herniation is especially harmful for fetal lung development because the liver is a large and mobile organ, unlike the bowels. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 44 · 1:06](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=66)
- Balloon removal after FETO is typically done by week 34. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 44 · 2:13](https://team.globalcastmd.com/watch/feto-for-late-diagnosed-severe-congenital-diaphragmatic-hernia-at-cincinnati-children-s-with-dr-beth-rymeski-14012?t=133)
- FETO uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it, trapping fluid in the lungs to allow expansion and growth. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 0:18](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=18)
- Imaging showed the tip of the liver reaching all the way up to the apex of the chest. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 0:36](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=36)
- The O/E is the observed to expected lung to head ratio. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 0:52](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=52)
- The PPLV on MRI was 7%. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 0:52](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=52)
- The balloon was placed early at 27 weeks and 4 days. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:02](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=62)
- This patient was the ideal case for FETO, with not a single hospitalization stay. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:06](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=66)
- The balloon was removed at 34 weeks. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:12](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=72)
- A non-responder is a fetus with CDH who received FETO but did not show any improvement in lung growth. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:23](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=83)
- Post-FETO imaging showed actual lung volume measurement just over 2 mL on the left side (compared to less than 1 mL initially). — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:32](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=92)
- The patient went into labor at 37 weeks and 3 days and had a vaginal delivery. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:45](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=105)
- The Apgars for the baby were 2 and 1. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 1:51](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=111)
- The baby had several unexpected findings after delivery, despite extensive prenatal imaging. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 2:03](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=123)
- Anorectal malformations are rarely diagnosed prenatally. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 2:21](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=141)
- Genetic testing showed only a few variations of unclear significance. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 2:43](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=163)
- The team was not confident they could repair the cardiac defect, especially for a baby who couldn't come off ECMO due to limited lung volume. — Jill Knepprath summarizes what Dr. Beth Rymeski said [Ep 43 · 2:58](https://team.globalcastmd.com/watch/severe-congenital-diaphragmatic-hernia-case-feto-management-unexpected-findings-with-dr-beth-rymeski-14011?t=178)
- Bivalirudin is a direct thrombin inhibitor used to prevent blood clots, especially during cardiac and vascular procedures. — Em Gootee summarizing the discussion [Ep 37 · 1:23](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=83)
- Dilute thrombin time for monitoring bivalirudin is five times more specific and sensitive than PTT and can be created by any lab. — Em Gootee summarizing the discussion [Ep 37 · 1:23](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=83)
- Bivalirudin has a very short half-life of approximately 20 minutes, allowing immediate effects when turned on or off. — Em Gootee summarizing the discussion [Ep 37 · 1:23](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=83)
- Bivalirudin has much less variability between patients in terms of anticoagulation effectiveness compared to heparin. — Em Gootee summarizing the discussion [Ep 37 · 1:23](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=83)
- Some groups perform risk stratification after initiating ECMO: high-risk babies proceed with earlier repair, while lower-risk babies are weaned off ECMO before repair. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- It is impossible to predict with 100% certainty which babies will successfully wean off ECMO, and late repair (when babies cannot come off ECMO) is the worst time to operate. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- Early repair on ECMO promotes good lung growth. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- Cannula position is important for assessing left-sided heart disease, which is a major contributor to overall cardiac function in CDH patients. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- Early repair places patients in a better position to come off ECMO urgently if needed. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- Out of 90 centers contributing to the CDH Study Group, almost 80% are performing early repair on ECMO. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- Practice patterns for CDH repair timing have shifted dramatically over the last three years. — Em Gootee summarizing the discussion [Ep 37 · 3:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=205)
- CDH repair can be safely performed on ECMO with minimal to no bleeding complications when meticulous operative techniques are used. — Em Gootee summarizing the discussion [Ep 37 · 4:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=265)
- The optimal window for early CDH repair on ECMO is between 8 to 24 hours after cannulation. — Em Gootee summarizing the discussion [Ep 37 · 4:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=265)
- Bivalirudin is a safe anticoagulant for CDH repair on ECMO. — Em Gootee summarizing the discussion [Ep 37 · 4:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=265)
- A smaller, consistent surgical team can enhance outcomes for CDH repair on ECMO. — Em Gootee summarizing the discussion [Ep 37 · 4:25](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-part-2-10890?t=265)
- The 13 French VV cannula is too big for some neonates, leading institutions to choose VA instead. — M. Gody summarizing the discussion [Ep 36 · 2:23](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=143)
- Better VV cannulas are coming out that may change practice patterns. — M. Gody summarizing the discussion [Ep 36 · 2:23](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=143)
- Michigan's SPHERE protocol prenatally selected severe CDH babies and had ECMO on standby in the delivery room. — M. Gody summarizing the discussion [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- SPHERE protocol criteria: within two hours post-delivery, if pH did not meet 7, PCO2 wasn't less than 100, and preductal sats weren't above 80, comfort measures only were offered; if criteria were met, ECMO was offered. — M. Gody summarizing the discussion [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- In the SPHERE protocol comparison, the two groups (comfort care vs ECMO) had equivalent survival. — M. Gody summarizing the discussion [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- Half of the patients offered comfort measures in SPHERE could have been survivors. — M. Gody summarizing the discussion [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- Half of the patients offered ECMO in SPHERE did not survive. — M. Gody summarizing the discussion [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- If you make the decision to choose ECMO versus comfort care beforehand using early criteria, you're going to be wrong 50% of the time. — M. Gody summarizing the discussion [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- Dr. Stark believes that if parents have good prenatal counseling and are all in, you should pursue ECMO for every unilateral isolated CDH. — M. Gody summarizes what Dr. Rebecca Stark said [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- Dr. Stark clarified she is not referring to cases involving genetic or cardiac syndromes, which she considers an entirely different scenario. — M. Gody summarizes what Dr. Rebecca Stark said [Ep 36 · 2:49](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=169)
- Early ECMO intervention is often preferred in severe CDH. — M. Gody summarizing the discussion [Ep 36 · 4:09](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=249)
- Veno-arterial ECMO is still widely used in CDH, though veno-venous ECMO may increase with improved cannulas. — M. Gody summarizing the discussion [Ep 36 · 4:09](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=249)
- Predicting outcomes in severe CDH remains imprecise despite protocols like SPHERE. — M. Gody summarizing the discussion [Ep 36 · 4:09](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=249)
- Many providers advocate for universally offering ECMO in cases of isolated unilateral CDH, approaching each infant as a potential survivor until proven otherwise. — M. Gody summarizing the discussion [Ep 36 · 4:09](https://team.globalcastmd.com/watch/update-course-rewind-when-how-to-operate-cdh-patients-on-ecmo-2024-10772?t=249)
- CITED2 expression is low at early lung development according to literature. — Marietta Jank summarizing the discussion [Ep 32 · 4:45](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=285)
- CITED2 deficient mice showed no difference in lung phenotype compared to controls at embryonic day 16.5. — Marietta Jank summarizing the discussion [Ep 32 · 4:55](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=295)
- CITED2 null mutant mice embryos at E17.5 and 18.5 showed signs of pulmonary immaturity with smaller lobe size, increased percentage of tissue and loss of air space. — Marietta Jank summarizing the discussion [Ep 32 · 5:05](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=305)
- CITED2 mutant rats showed arrest at canalicular stage. — Marietta Jank summarizing the discussion [Ep 32 · 5:20](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=320)
- CITED2 itself is induced by proinflammatory stimuli like LPS, interleukins, interferon gamma and TNF alpha according to current literature. — Marietta Jank summarizing the discussion [Ep 32 · 5:25](https://team.globalcastmd.com/watch/dr-marietta-jank-best-of-the-best-in-pediatric-surgery-2025-10039?t=325)
- The diaphragm is a muscle separating the chest from the abdomen. — The host summarizing a resource [Ep 27 · 0:01](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=1)
- Sometimes a baby's diaphragm does not form properly during pregnancy, resulting in an opening in the diaphragm. — The host summarizing a resource [Ep 27 · 0:20](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=20)
- It is most common for the diaphragmatic opening to be on the left side, but it can be on the right side or both. — The host summarizing a resource [Ep 27 · 0:35](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=35)
- Contents of the abdomen, such as the stomach, intestine, and or liver, can go through the opening into the chest in CDH. — The host summarizing a resource [Ep 27 · 0:45](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=45)
- CDH is classed as a rare birth defect. — The host summarizing a resource [Ep 27 · 0:55](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=55)
- CDH can sometimes happen alongside other malformations, but in most cases it is sporadic. — The host summarizing a resource [Ep 27 · 1:05](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=65)
- The cause of CDH is largely unknown, but it has been associated with other rare genetic diseases. — The host summarizing a resource [Ep 27 · 1:15](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=75)
- The presence of abdominal contents in the chest impacts the growth and development of the baby's lungs, normally leading to small lungs (hypoplasia) and poor lung function. — The host summarizing a resource [Ep 27 · 1:25](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=85)
- CDH can affect the heart by pushing it out of its normal position and competing for space. — The host summarizing a resource [Ep 27 · 1:40](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=100)
- A diagnosis of CDH can be made before birth using ultrasound and MRI. — The host summarizing a resource [Ep 27 · 1:50](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=110)
- Ongoing care for babies with CDH should be provided at a specialist center by a dedicated team of professionals with knowledge and experience of CDH. — The host summarizing a resource [Ep 27 · 2:00](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=120)
- Some unborn babies with CDH may be suitable for surgical intervention before birth (fetal therapy) to support lung development. — The host summarizing a resource [Ep 27 · 2:15](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=135)
- CDH is a serious condition and can be life threatening for the baby before and after birth. — The host summarizing a resource [Ep 27 · 2:25](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=145)
- Many babies with CDH do survive. — The host summarizing a resource [Ep 27 · 2:35](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=155)
- After birth, babies with CDH receive immediate care and assessment and are transferred to a dedicated intensive care unit. — The host summarizing a resource [Ep 27 · 2:40](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=160)
- Babies with CDH require assistance with breathing and feeding and other intensive care support. — The host summarizing a resource [Ep 27 · 2:50](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=170)
- When the baby is stable, surgery can take place to close the opening in the diaphragm. — The host summarizing a resource [Ep 27 · 2:55](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=175)
- The amount of time a baby with CDH will spend in hospital differs depending on the severity of the CDH, any complications, and how well they respond to treatment. — The host summarizing a resource [Ep 27 · 3:02](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=182)
- Follow up care by a multidisciplinary team (MDT) is required for babies with CDH. — The host summarizing a resource [Ep 27 · 3:10](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=190)
- Some babies with CDH may experience ongoing difficulties such as feeding difficulties that require different types and levels of care. — The host summarizing a resource [Ep 27 · 3:10](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=190)
- Identifying any complications or difficulties early in babies with CDH is very important. — The host summarizing a resource [Ep 27 · 3:10](https://team.globalcastmd.com/watch/what-is-congenital-diaphragmatic-hernia-an-ernica-animation-for-parents-and-families-7810?t=190)
- Individuals born with congenital anomalies such as congenital diaphragmatic hernia or esophageal atresia are at increased risk of gastroesophageal reflux, which can be worsened by both alcohol and smoking. — The host summarizing a resource [Ep 26 · 0:01](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=1)
- In the case of congenitally underdeveloped alveoli, smoking is a direct cause of emphysema, which can result in chronic airway inflammation. — The host summarizing a resource [Ep 26 · 0:01](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=1)
- Smoking can cause pulmonary hypertension, and individuals with congenital anomalies may already be at increased risk of this due to their condition. — The host summarizing a resource [Ep 26 · 0:01](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=1)
- Respiratory symptoms in patients with congenital anomalies cannot be unequivocally linked to smoking and may signal congenital lung disease, which should be considered when deciding on the patient's treatment plan. — The host summarizing a resource [Ep 26 · 0:01](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=1)
- Alcohol and smoking both lower the tone of the oesophageal sphincter, thus increasing gastroesophageal reflux and subsequently the risk of Barrett's esophagus and esophageal cancer. — The host summarizing a resource [Ep 26 · 1:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=60)
- Alcohol and smoking are both related to the development of esophageal squamous carcinoma. — The host summarizing a resource [Ep 26 · 1:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=60)
- Those who have had fundoplication surgery might face some difficulties vomiting in case of excessive alcohol consumption. — The host summarizing a resource [Ep 26 · 1:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=60)
- Drinking alcohol can result in the development of fatty liver disease, subsequent cirrhosis and liver failure due to portal hypertension. — The host summarizing a resource [Ep 26 · 2:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=120)
- Patients with intestinal failure may be receiving parenteral nutrition for long periods, which has already been found to be linked to fatty liver disease. — The host summarizing a resource [Ep 26 · 2:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=120)
- Smoking can lead to arterial stenosis, which can impair kidney function. — The host summarizing a resource [Ep 26 · 2:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=120)
- Kidney function can already be impaired for patients with congenital anomalies such as intestinal failure and VACTERL association. — The host summarizing a resource [Ep 26 · 2:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=120)
- Smoking is linked to bladder cancer. — The host summarizing a resource [Ep 26 · 2:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=120)
- Smoking and alcohol can both lower the intestinal transit time, which can have a negative impact for patients with intestinal failure, especially short bowel syndrome, and patients with anorectal malformations and Hirschsprung's disease requiring complex bowel management. — The host summarizing a resource [Ep 26 · 3:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=180)
- Alcohol can alter the gut microbiome and may correlate with a higher incidence of early onset colorectal cancer for patients with congenital intestinal diseases. — The host summarizing a resource [Ep 26 · 3:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=180)
- For patients with intestinal failure specifically, alcohol needs to be viewed as an additional sugar source. — The host summarizing a resource [Ep 26 · 3:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=180)
- Bowel absorption capacity may be increased for patients with intestinal failure, meaning that individuals require lower quantities of alcohol to feel the effects. — The host summarizing a resource [Ep 26 · 3:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=180)
- Clinicians should be encouraged to share information on how alcohol and smoking can affect patients with congenital anomalies, so that patients can make an informed choice. — The host summarizing a resource [Ep 26 · 3:00](https://team.globalcastmd.com/watch/transition-of-care-alcohol-and-smoking-7648?t=180)
- This is a retrospective study conducted at Boston Children's Hospital comparing postoperative bleeding in CDH patients on ECMO repaired early versus late. — Cecilia Gigena summarizing a resource [Ep 25 · 0:00](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539?t=0)
- The study included 146 patients total: 102 repaired early and 44 repaired late. — Cecilia Gigena summarizing a resource [Ep 25 · 0:00](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539?t=0)
- Patients repaired late had an odds ratio of 11.7 times greater risk for postoperative bleeding compared to early repair. — Cecilia Gigena summarizing a resource [Ep 25 · 0:00](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539?t=0)
- Patients repaired early had much shorter ECMO runs. — Cecilia Gigena summarizing a resource [Ep 25 · 0:00](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539?t=0)
- If you have a CDH patient on ECMO, it appears better to repair early. — Cecilia Gigena summarizing a resource [Ep 25 · 0:00](https://team.globalcastmd.com/watch/el-momento-de-la-reparaci-n-de-la-hdc-en-ecmo-influye-en-el-riesgo-de-hemorragia-quir-rgica-7539?t=0)
- According to the US Centers for Disease Control and Prevention, the incidence of CDH is 2.6 per 10,000 births. — Em Tombash summarizing a resource [Ep 23 · 0:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=0)
- The pathophysiology of CDH is not well understood, and we don't know why these babies have lung hypoplasia and severe pulmonary hypertension. — Em Tombash summarizing a resource [Ep 23 · 2:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=120)
- The diaphragmatic defect causes abdominal viscera to herniate to the chest, creating lung compression and lung hypoperfusion. — Em Tombash summarizing a resource [Ep 23 · 2:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=120)
- In the nitrofen model, rats were given intragastrically 100 milligrams of nitrofen dissolved in 1 milliliter of olive oil at 9.5 days, with euthanization on day 21.5 before pups were born. — Em Tombash summarizing a resource [Ep 23 · 4:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=240)
- All pups' lungs were harvested in less than 50 minutes to minimize hypoxia. — Em Tombash summarizing a resource [Ep 23 · 4:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=240)
- HIF mRNA and protein levels are elevated in the fetal lung with the entire HIF system activated at eight weeks of gestation in the human. — Em Tombash summarizing a resource [Ep 23 · 4:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=240)
- When HIF-1 Alpha is exposed to oxygen in normoxia, it has a short half-life which is less than five minutes. — Em Tombash summarizing a resource [Ep 23 · 4:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=240)
- HIF-1 Alpha gene expression analyzed by qPCR is significantly different between the nitrofen CDH and vehicle control. — Em Tombash summarizing a resource [Ep 23 · 4:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=240)
- Under decreased concentrations of oxygen, the degradation of HIF alpha is retarded, which can explain why protein expression of HIF is increased in the periphery of CDH lungs. — Em Tombash summarizing a resource [Ep 23 · 4:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=240)
- Glucose is the primary energy source of the lungs and is essential for energy production and surfactant synthesis. — Em Tombash summarizing a resource [Ep 23 · 6:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=360)
- Glucose Transporter One (GLUT1) increases in lung tissue under hypoxia. — Em Tombash summarizing a resource [Ep 23 · 6:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=360)
- In fetal rats, GLUT1 mRNA expression increases to maximum levels at gestation day 20 and falls to very low levels by postnatal day 8. — Em Tombash summarizing a resource [Ep 23 · 6:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=360)
- GLUT1 gene expression evaluated by qPCR is upregulated in CDH. — Em Tombash summarizing a resource [Ep 23 · 6:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=360)
- Glucose is not decreased in the lungs with CDH when evaluated by NMR spectroscopy. — Em Tombash summarizing a resource [Ep 23 · 6:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=360)
- Both HIF-1α and GLUT1 manifest in the airways. — Em Tombash summarizing a resource [Ep 23 · 6:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=360)
- Metabolomic investigation of complete fetal lungs published last year indicates the presence of a unique metabolic profile in the nitrofen-induced CDH fetal lungs. — Em Tombash summarizing a resource [Ep 23 · 8:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=480)
- CDH lungs show evident changes in energy production, redox control state, and cell proliferation, associated with lung hypoplasia caused by nitrofen and aggravated by lung compression. — Em Tombash summarizing a resource [Ep 23 · 8:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=480)
- Healthy cells must maintain a high ratio of ATP to ADP in the order of 10 ATPs for each ADP, and ADP to AMP in the order of 100 ADPs for each AMP. — Em Tombash summarizing a resource [Ep 23 · 8:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=480)
- In CDH lungs, ADP is decreased and AMP is increased. — Em Tombash summarizing a resource [Ep 23 · 8:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=480)
- Normal energy charge varies between 0.7 and 0.95, and oxidations in this range are very frequent and normal. — Em Tombash summarizing a resource [Ep 23 · 8:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=480)
- CDH lungs are in energetic failure with an energy charge level of 0.15. — Em Tombash summarizing a resource [Ep 23 · 8:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=480)
- Fetal CDH lungs are compressed and probably with chronic hypoxia, have a different metabolism with significant alteration in glycolytic energy, antioxidant, and nucleotide metabolites. — Em Tombash summarizing a resource [Ep 23 · 10:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=600)
- The metabolic changes found in fetal CDH are compatible with growth arrest and tissue remodeling. — Em Tombash summarizing a resource [Ep 23 · 10:00](https://team.globalcastmd.com/watch/cdh-live-webinar-series-part-1-research-lung-compression-in-cdh-generates-cellular-chronic-hypoxia-and-energy-failure-6641?t=600)
- A New England Journal of Medicine paper described enzyme replacement therapy administered via umbilical vein multiple times (at least six times every second week). — Rebecca Figueira summarizing a resource [Ep 18 · 8:46](https://team.globalcastmd.com/watch/bob-in-ped-surg-2023-eupsa-winner-dr-rebeca-figueira-6326?t=526)

## Changelog
- Sep 24: 19 items added automatically
- Sep 22: 1 item added automatically
- Sep 20: 2 items added automatically
- Sep 19: 1 item added automatically
- Sep 17: 3 items added automatically
- Sep 16: 3 items added automatically
- Sep 16: 1 item no longer name congenital diaphragmatic hernia
- Sep 15: 3 items added automatically
- Sep 10: 2 items no longer name congenital diaphragmatic hernia
- Sep 7: Published again automatically — condition is back above threshold
- Sep 7: 2 items no longer name congenital diaphragmatic hernia
- Sep 7: 8 items added automatically
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: 9 items added automatically

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