title: International Survey on the Management of Congenital Diaphragmatic Hernia.
abstract: OBJECTIVE
  This study aims to define patterns in the management of congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  A total of 180 delegates (77% senior surgeons) from 44 (26 European) countries completed a survey at the 2014 European Pediatric Surgeons' Association meeting.
  
  
  RESULTS
  Overall, 34% of the surgeons work in centers that treat < 5 cases of CDH/y, 38% work in centers that treat 5 to 10 cases/y, and 28% work in centers that treat > 10 cases/y. Overall, 62% of the surgeons work in extra corporeal membrane oxygenation (ECMO) centers and 23% in fetal surgery centers. Prenatal work up and delivery: 47% surgeons request prenatal magnetic resonance imaging, 53% offer karyotyping, 22% perform a fetal intervention, 74% monitor head-to-lung ratio, and 55% administer maternal steroids. Delivery is via cesarean section for 47% surgeons, at 36 to 38 weeks for 71% surgeons, and in a tertiary care center for 94% of the surgeons. POSTNATAL MANAGEMENT: A total of 76% surgeons report elective intubation, 65% start antibiotics preoperatively, and 45% administer surfactant. In case of refractory hypoxia, 66% surgeons consider ECMO with a variable course. Parenteral feeding is started preoperatively by 56% of the surgeons. Only 13% of the surgeons request contrast studies preoperatively to rule out malrotation.
authors.affiliation: Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Augusto
authors.initials: A
authors.lastname: Zani
authors.affiliation: Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.affiliation: Department of Paediatric Surgery, National Children's Research Centre, Dublin, Ireland.
authors.forename: Prem
authors.initials: P
authors.lastname: Puri
authors.affiliation: Department of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, Belgrade, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Lukac
authors.affiliation: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagolan
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany.
authors.forename: Joachim F
authors.initials: JF
authors.lastname: Kuebler
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Friedmacher
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hoellwarth
authors.affiliation: Department of Pediatric Surgery, Sophia Children's Hospital, ErasmusMC, Rotterdam, The Netherlands.
authors.forename: Rene
authors.initials: R
authors.lastname: Wijnen
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Tovar
authors.affiliation: Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D005060:Europe; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis* / Q000628:therapy*; D059685:Herniorrhaphy / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000706:statistics & numerical data; D019141:Respiratory System Agents / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents; D019141:Respiratory System Agents; D013256:Steroids