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The Canadian Pediatric Surgery Network Le Réseau Canadien de Chirurgie Pédiatrique

Version 1 March 2018

CAPSNet 2017 Annual Report

TABLE OF CONTENTS TABLE OF CONTENTS ...............................................................................................................................................................1

INTRODUCTION TO THE NETWORK ........................................................................................................................................1

RECENT NETWORK ACTIVITY ..................................................................................................................................................1

PUBLISHED CDH GUIDELINES AND PODCAST ......................................................................................................................... 1 CAPSNET DATA ABSTRACTION COSTS .................................................................................................................................. 1

OTHER PROJECTS .....................................................................................................................................................................2

NEXT STAGE IN EVIDENCE-BASED PAEDIATRIC SURGICAL TREATMENT STRATEGIES (NETS) – OUTCOMES FROM

HARMONIZED COHORTS OF INFANTS BORN WITH GASTROSCHISIS ........................................................................................... 2 STRATEGY FOR THE IMPLEMENTATION OF CONSENSUS-BASED CLINICAL MANAGEMENT GUIDELINES OF CDH ....................... 3 DEVELOPMENT OF MULTIDISCIPLINARY PRACTICE GUIDELINES FOR NECROTIZING ENTEROCOLITIS (NEC) ........................... 3

UPDATES TO THE ANNUAL REPORT ......................................................................................................................................3

ACKNOWLEDGEMENTS ............................................................................................................................................................4

2017 DATA ANALYSIS (DATA UNTIL DECEMBER 31, 2016) .................................................................................................5

CONTRIBUTING CENTRES FOR THE 2017 ANNUAL REPORT .................................................................................................... 5 SUMMARY OF DATA BY DIAGNOSIS AND BIRTH OUTCOMES................................................................................................... 6 Graph A: Distribution of GS cases by centre ................................................................................................................ 7 Graph B: Distribution of CDH cases by centre .............................................................................................................. 7

GASTROSCHISIS DESCRIPTIVE ANALYSES ............................................................................................................................... 8 Table 1.0: Patient population ........................................................................................................................................... 8 Table 1.1: Survival by centre volume ............................................................................................................................ 8 Gastroschisis Prognostic Score (GPS) .......................................................................................................................... 8 Figure 1.2: Maximum bowel dilation reported on antenatal ultrasound................................................................... 10 Figure 1.3: Early vs. late antenatal referral .................................................................................................................. 10 Graph 1.4: Gestational age at birth............................................................................................................................... 11 Table 1.5: Antenatal Delivery Plan as of 32 Weeks Gestational Age ...................................................................... 11 Graph 1.6: Proportion of Caesarean Section Grouped By Site - 2005 to 2016 ..................................................... 12 Table 1.7: Timing of gastroschisis closure .................................................................................................................. 13 Graph 1.8: Surgeon’s treatment intent by centre ........................................................................................................ 13 Figure 1.9: Method of Surgical Closure ....................................................................................................................... 14 Figure 1.9a: Method of surgical closure – 2005 to 2010 ........................................................................................... 14 Figure 1.9b: Method of surgical closure – 2011 to 2016 ........................................................................................... 14 Table 1.10: Operative success ...................................................................................................................................... 15 Figure 1.11a: Proportional gastroschisis prognostic score (GPS) scoring ............................................................. 15 Table 1.11b: Selected neonatal outcomes stratified by GPS Risk........................................................................... 16 Table 1.12 a: Selected neonatal outcomes stratified by urgent closure, delayed closure and cord flap closure

........................................................................................................................................................................... 17 Table 1.12 b: Location of closure stratified by urgent closure, delayed closure and cord flap closure .............. 17 Graph 1.13: Selected neonatal complications ............................................................................................................ 18

CONGENITAL DIAPHRAGMATIC HERNIA DESCRIPTIVE ANALYSES ....................................................................................... 19 Table 2.0: Patient population ......................................................................................................................................... 19 Table 2.1: Survival by centre volume ........................................................................................................................... 20 Figure 2.2: Maximum lung-head ratio (LHR)* ............................................................................................................. 20 Figure 2.3: Early vs. late initial Visit .............................................................................................................................. 21 Graph 2.4: Gestational age at birth............................................................................................................................... 21 Graph 2.5: Proportion of caesarean delivery grouped by site - 2005 to 2016........................................................ 22 Graph 2.6: Mean age at surgical repair by centre ...................................................................................................... 22 Figure 2.7: Method of surgical closure ......................................................................................................................... 23 Graph 2.8: Size of CDH defect ...................................................................................................................................... 23 Graph 2.9: Selected neonatal complication ................................................................................................................. 24 Graph 2.10a: Selected neonatal outcomes at discharge .......................................................................................... 25 Table 2.10b: Selected neonatal outcomes .................................................................................................................. 25

APPENDIX I: DEFINITIONS ..................................................................................................................................................... 26

APPENDIX II: LIST OF PUBLICATIONS, PRESENTATIONS AND ONGOING PROJECTS ................................................ 27

2017 CAPSNet Annual Report Page 1 of 38

INTRODUCTION TO THE NETWORK The Canadian Pediatric Surgery Network (CAPSNet) is a multi-disciplinary group of Canadian health researchers working together on research issues concerning pediatric surgical care. To date, there are 30 network members, including 21 pediatric surgeons, 5 perinatologists/maternal fetal medicine specialists and 4 neonatologists. The main objectives of the network are to:

Maintain a national pediatric surgical database, providing an infrastructure to facilitate and encourage collaborative national research.

Identify variations in clinical practices across Canadian centres and identify those practices which are associated with favourable and unfavourable outcomes.

Disseminate new knowledge through effective knowledge translation, and study impact of practice change.

Study the economic impact of clinical practice decisions to enable identification of treatment strategies that are efficacious and cost-effective.

Currently, CAPSNet is in its 12th year of data collection and we are pleased to report that the Network has produced 47 published manuscripts, with 2 in press. The Network has also presented at 68 national and international conferences (podium or poster presentations). For a complete list of all past and current CAPSNet projects, please see Appendix II.

RECENT NETWORK ACTIVITY

PUBLISHED CDH GUIDELINES AND PODCAST

A set of evidence-based and consensus-driven national clinical practice guidelines CDH patients, titled Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline, was recently published in CMAJ on Jan 2018. These guidelines encompass the complete trajectory of care for CDH infants from prenatal diagnosis, to acute in-hospital care to long-term surveillance. Key points from the article include:

CDH severity can be determined using observed to expected lung-head ratios, total fetal lung volumes, and fetal liver position.

CDH infants require intensive cardiopulmonary support after birth (immediate endotracheal intubation, gentle ventilation, judicious fluid and inotropic support)

If ECHO detects pulmonary hypertension in CDH patients, pulmonary vasodilators and in some extreme cases, extracorporeal life support, may be required.

Open surgical repair should be delayed until the patient is physiologically stable; however is surgery is not performed within two weeks of life, priorities should be discussed with the family

CDH infants should have long term, multidisciplinary follow-up, especially if the patient is considered high risk.

A podcast is linked to the guidelines. The audio from the podcast can be found on https://soundcloud.com/cmajpodcasts/170206-guide.

CAPSNET DATA ABSTRACTION COSTS

Our centres across Canada continue to seek alternate funding sources to ensure the longevity of the project. The Network is a valuable source of data for researchers across Canada and is also an excellent resource for national benchmarking, which can lead to improved health

https://soundcloud.com/cmajpodcasts/170206-guide


services for CDH and gastroschisis babies. Kudos to the centres that have made this successful transition and thanks to those centres that continue to seek out funding for the project. As of March 2018, centres now paying for their own data abstraction are:

SITE PROVINCE BC Children's Hospital British Columbia

Victoria General Hospital British Columbia

Alberta Children’s Hospital (Calgary) Alberta

Royal University Hospital Saskatchewan

Winnipeg Health Sciences Centre Manitoba

Children’s Hospital of Eastern Ontario Ontario

McMaster Children’s Hospital Ontario

London Health Sciences Centre Ontario

The Hospital for Sick Children Ontario

Montreal Children's Hospital Quebec

IWK Health Centre Nova Scotia

Janeway Children’s Health and Rehabilitation Centre

Newfoundland

OTHER PROJECTS

NEXT STAGE IN EVIDENCE-BASED PAEDIATRIC SURGICAL TREATMENT STRATEGIES

(NETS) – OUTCOMES FROM HARMONIZED COHORTS OF INFANTS BORN WITH

GASTROSCHISIS

Mr. Benjamin Allin, Paediatric Surgical Registrar in the Nuffield Department of Surgery and Doctoral Research Fellow at the National Perinatal Epidemiology Unit, University of Oxford will be working with Junmin Yang, a CNN biostatistician, to merge and analyze the gastroschisis data collected from the British Association of Pediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS) in the United Kingdom (UK) with the gastroschisis cases in the CAPSNet database. The analysis will aim to address three questions:

i. What are the core neonatal outcomes for infants born with gastroschisis, and which patient characterises are associated with variation in these outcomes?

ii. Does the choice of operative strategy affect neonatal outcomes? iii. Is there a variation between the UK and Canada in management strategy and

neonatal outcomes for infants with gastroschisis. All data will be merged and analyzed In Toronto. Data will not leave the MiCare site and the BAPS-CASS data will be promptly deleted from the MiCare server following completion of the analysis.


STRATEGY FOR THE IMPLEMENTATION OF CONSENSUS-BASED CLINICAL MANAGEMENT

GUIDELINES OF CDH

Dr. Pramod S. Puligandla and Dr. Kathryn Larusso (research fellow, MCH) are working to implement the CDH guidelines published in CMAJ this year using a four-staged approach:

A. Assessment of individual institutional readiness for clinical practice guidelines implementation.

I. All CAPSNet sites will be sent an online questionnaire, The Organizational Change Questionnaire-Climate of Change, Processes, and Readiness: Development of a New Instrument, using survey monkey.

II. Three sites (MCH, BCCH, and HSCC) will participate in an alpha phase, where an implementation team will be identified. The team will consist of a clinical leader (surgeon/intensivist), day-to-day champion (nurse/team leader), and other stakeholders.

B. Identifying and overcoming local implementation barriers - Any barriers identified in the Alpha sites (MCH, BCCH, and HSCC) for guideline

implementation will be addressed using training. Training methods include webinars and electronic learning modules and support tools.

C. Development of Electronic Support Tools: - A support app will be developed to provide easy-access to the guidelines,

calculators for key indices (lung head ratio and oxygenation), evidence summaries, individual recommendations, flow sheets, and quality assurance/compliance tools.

D. Assessment of the guidelines on patient outcomes - CDH outcome measures will be compared between the three alpha sites and the

other CAPSNet sites. The goal of this project is to understand how to effectively and successfully implement clinical practice guidelines across all Canadian CAPSNet sites.

DEVELOPMENT OF MULTIDISCIPLINARY PRACTICE GUIDELINES FOR NECROTIZING

ENTEROCOLITIS (NEC) In partnership with the Dr. Prakesh Shah and CNN, a group of neonatologists, surgeons and pediatric radiologists are working collaboratively to develop evidence-based guidelines for the diagnosis, medical and surgical management of babies with necrotizing enterocolitis (NEC). Using a method similar to the process used to develop CDH guidelines, this group had their first face-to-face meeting following the recent (February, 2018) CNPRM meeting in Banff.

UPDATES TO THE ANNUAL REPORT New updates to the annual report is the addition of two new columns, Indigenous and Non-Indigenous Peoples to the following tables:

Summary of data by birth by diagnosis and outcome (Page 6)

Gastroschsis Descriptive Analysis (Table 1, page 8)

Gastroschsis Selected Neonatal Outcomes stratified by GPS risk (Table 2.11b, page 10)

CDH Patient population (Table 2.0, page 19)

CDH Selected Neonatal Outcomes (Table 2.10b, page 25)


ACKNOWLEDGEMENTS We would like to acknowledge the CAPSNet Steering Committee members for their leadership and commitment to the Network: Dr. Sarah Bouchard Hôpital Ste‐Justine, Montréal

Dr. Ioana Bratu University of Alberta, Edmonton

Dr. Mary Brindle University of Calgary, Calgary

Dr. Priscilla Chiu Hospital for Sick Children, Toronto

Dr. Helen Flageole McMaster University Medical Centre, Hamilton

Dr. Sharifa Himidan Hospital for Sick Children, Toronto

Dr. Richard Keijzer Children’s Hospital, Winnipeg

Dr. Jean‐Martin Laberge Montréal Children’s Hospital, Montréal

Dr. Aideen Moore Mount Sinai Hospital, Toronto – Neonatology

Dr. Agostino Pierro Hospital for Sick Children, Toronto

Dr. Pramod Puligandla Montréal Children’s Hospital, Montréal

Dr. Greg Ryan Mount Sinai Hospital, Toronto‐Perinatology

Dr. Prakeshkumar S Shah Mount Sinai Hospital, Neonatology

Dr. Erik Skarsgard BC Children’s Hospital, Vancouver

Dr. Doug Wilson University of Calgary, Calgary‐Perinatology

Dr. Jessica Mills IWK Health Centre, Halifax

We send our sincere appreciation to Sonny Yeh, the MiCare System Administrator at Mount Sinai Hospital, and Amara Rivero, MiCare Database Developer, for their work in compiling the national dataset, updating the CAPSNet software, and maintaining the database. We acknowledge each of our Data Abstractors (past and present), whose attention to detail and high quality work serves as the foundation for the database. Many thanks to: Afsaneh Afshar, Debbie Arsenault, Sheryl Atkinson, Margaret Baker, Charlene Cars, Lola Cartier, Megan Clark, Natalie Condron, Kamary Coriolano, Valerie Cook, Jacob Davidson ,Victoria Delio, Alda DiBattista, Nathalie Fredette, Aimee Goss, Faye Hickey, Ullas Kapoor, Erin Kehoe, Robin Knighton, Lizy Kodiattu, Ali MacRobie, Tanya McKee, Richa Metha, Nima Mirakhur, Loreanne D’Orazio, Kruti Patel, Daniel Pierrard, Rashmi Raghavan, MaryJo Ricci, Margaret Ruddy, Andrea Secord, Wendy Seidlitz, Ellen Townson, François Tshibemba, Nicole Tucker, Jocelyne Vallée, Danielle Vallerand, and Susan Wadsworth. We also acknowledge the many trainees, their site sponsors and the CAPSNet Steering Committee members who have used and continue to use both site and aggregate data for analyses (for a full list of ancillary projects to date, see Appendix II). CAPSNet is grateful for the financial support received from the Canadian Institutes of Health Research (CIHR), the Executive Council of the Canadian Association of Pediatric Surgeons (CAPS), the CIHR team in Maternal‐Infant Care (MiCare) as well as in‐kind contributions from CNN.


2017 DATA ANALYSIS (DATA UNTIL DECEMBER 31, 2016) This CAPSNet Annual Report combines data from two versions of the CAPSNet database (2005 and 2012) and includes babies born until December 31, 2016. Every effort was made to analyze the data in a manner that unifies all variables and considers any changes in definitions. Babies born until December 31, 2011 were entered into the old database version. For all data requests, it is important to note that new variables added into the database redesign will only be available for babies born January 1st, 2012 or later. Cases included in this report were from the CAPSNet centres listed below. All cases meet the CAPSNet eligibility criteria of a diagnosis of Gastroschisis (GS) or Congenital Diaphragmatic Hernia (CDH) made prenatally or within 7 days of life. Data from the CAPSNet database has been cleaned by the CAPSNet coordinating centre and checked with abstractors in the event of a possible discrepancy. Data from the CNN database was cleaned by the CNN coordinating centre. Individual cases are attributed to the centre in which the surgery took place (i.e., if a baby was admitted at CAPSNet centre A but transferred to CAPSNet centre B for surgery, the baby is included as a case for CAPSNet centre B). Finally, information from transfers within CAPSNet or CNN have been linked where possible in order to provide as complete of a picture as possible for the baby’s complete course of hospital care.

CONTRIBUTING CENTRES FOR THE 2017 ANNUAL REPORT

Site City Province

Victoria General Hospital Victoria BC

British Columbia Children’s Hospital Vancouver BC

Alberta Children’s Hospital Calgary AB

University of Alberta Hospital Edmonton AB

Royal University Hospital Saskatoon SK

Winnipeg Health Sciences Centre in cooperation with St. Boniface General Hospital

Winnipeg Winnipeg

MB MB

Hospital for Sick Children in cooperation with Mount Sinai Hospital

Toronto Toronto

ON ON

McMaster Children’s Hospital Hamilton ON

London Health Sciences Centre London ON

Kingston General Hospital *Kingston General Hospital 2011- 2016 data was not available at the time of preparation of this annual report.

Kingston ON

Children’s Hospital of Eastern Ontario in cooperation with The Ottawa Hospital

Ottawa Ottawa

ON ON

Montréal Children’s Hospital in cooperation with McGill University Health Centre

Montréal Montréal

QC QC

Hôpital Ste-Justine Montréal QC

Centre Hospitalier de L’Université Laval Ste-Foy QC

IWK Health Centre Halifax NS

Janeway Children’s Health and Rehabilitation Centre St. John’s NL

2017 CAPSNet Annual Report - Page 6 of 39

SUMMARY OF DATA BY DIAGNOSIS AND BIRTH OUTCOMES *Cases included in this analysis are grouped as aggregate data for babies born from 2005 to December 31

st, 2016.

Congenital Diaphragmatic Hernia (CDH)

Gastroschisis (GS)

CAPSNet total

Indigenous Non-

Indigenous All CDH cases

Indigenous Non-

Indigenous All GS cases

Complete live births 19 677 696 120 1092 1212 1908

Still-births and spontaneous abortions

0 10 10 0 18 18 28

Elective Terminations 2 92 94 0 19 19 113

Died prior to CAPSNet admission Represents live births where the infant did not survive to admission at a CAPSNet tertiary pediatric centre (eg. Live births in a community setting where the baby did not survive transfer, or live births at a non-CAPSNet with a planned palliative approach).

1 23 24 0 3 3 27

Unknown/Lost 0 12 12 0 11 11 23

Total Cases 22 814 836 120 1143 1263 2099

C


GRAPH A: DISTRIBUTION OF GS CASES BY CENTRE

GRAPH B: DISTRIBUTION OF CDH CASES BY CENTRE

0

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250

A B C D E F G H I J K L M N O P

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Still-births andspontaneousabortions

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GASTROSCHISIS DESCRIPTIVE ANALYSES

TABLE 1.0: PATIENT POPULATION

Indigenous complete live births (n=120)

Non-Indigenous complete live

births (n=1092)

GS complete live births (n=1212)

Overall survival rate* 98.3% 96.0% 96.2%

Inborn rate 69.2% 77.7% 76.9%

Mean birth weight (g) 2700.1 (n=120) 2496.5 (n=1081) 2516.9 (n=1201)

Mean GA (weeks) 36.5 (n=120) 36.0 (n=1082) 36.1 (n=1202)

Proportion of males 48.3% 52.5% 52.1%

No prenatal diagnosis 7.5% 4.1% 4.5%

Proportion of males with undescended testis/testes

12.1% 16.2% 15.8%

Isolated defect** 84.2% 77.0% 77.7%

SNAP-II scores***

Recorded SNAP-II scores

Recorded survivor scores

Recorded non- survivor scores

Mean - survivors

Mean -non- survivors

Median- survivors

Median-non-survivors

115

113

2

9.0

25.5

5

25.5

1056

1013

43

9.1

13.9

5

7

1171

1126

45

9.1 14.4

5

7

* Cases with a reported discharge destination as “home” or “hospital” were grouped under survivors. ** An isolated defect determined based on the absence of other congenital anomalies as entered in the CNN database. ***SNAP-II: Score for Neonatal Acute Physiology, version II. See Appendix I for definitions.

TABLE 1.1: SURVIVAL BY CENTRE VOLUME

The following table shows the survival rate grouped by centre volume. Low volume centres are those that see an average of <3 GS cases per year, high volume centres see an average ≥ 9 GS cases per year; and mid volume centres includes all those in between.

GASTROSCHISIS PROGNOSTIC SCORE (GPS)

The Gastroschisis Prognostic Score (GPS) was developed by Cowan et al1 using CAPSNet data collected at the time of the surgeon’s first visual assessment of the bowel. The bowel injury variables (matting, atresia, necrosis, perforation) were weighted based on a regression analysis,

1 Cowan KN, Puligandla PS, Laberge JM, Skarsgard ED, Bouchard S, Yanchar N, Kim P, Lee SK, McMillan D, von Dadelszen P, and the Canadian Pediatric Surgery Network. The Gastroschisis Prognostic Score: Outcome prediction in Gastroschisis. J Pediatr Surg 2012 Jun;47(6):1111-7..


thus creating the GPS, which was validated using the CAPSNet database (patients born May 2005–May 2009). The GPS risk group is assigned based on the composite GPS score. For scores of <2, the patient is considered low risk. Patients are considered as high risk for morbidity if their score is ≥ 2 while infants with scores ≥ 4 have a high risk for both morbidity and mortality.

SNAP-II Gastroschisis Prognostic Score (GPS)

Centre volume Count (n)

Survival (%)

Median Range Mean Range

High (4 centres) 566 96.6% 5 0-51 1.5 0-12

Mid (9 centres) 591 95.9% 7 0-68 1.5 0-12

Low (3 centres) 55 94.5% 10 0-50 1.1 0-10

* Non-survivors are defined as those babies whose discharge destination was reported as “died”. All other cases reported as discharged to “home”, “hospital” or another destination were grouped under survivors.

GS Ultrasound Measurements Bowel dilation measurements taken during ultrasound examinations at 4 different time points were recorded as follows:

1. First ultrasound taken at the tertiary CAPSNet centre; 2. Last ultrasound taken between 23+0 and 31+6 weeks; 3. Last ultrasound taken between 32+0 and 34+6 weeks; and 4. Last ultrasound before delivery

The data presented reflects the worst (i.e. greatest) measurement reported on any of the above ultrasounds. No dilation information reported indicates that at least one ultrasound examination was recorded but the variable was not measured or reported; dilated, but no measurement indicates that bowel dilation was reported in at least one ultrasound, but no measurement was provided; no ultrasound indicates that no ultrasound examination was recorded; no dilation indicates that no ultrasound reported a dilation measurement and at least one ultrasound reported that there was no dilation.


FIGURE 1.2: MAXIMUM BOWEL DILATION REPORTED ON ANTENATAL ULTRASOUND

FIGURE 1.3: EARLY VS. LATE ANTENATAL REFERRAL

Not referred means that the mother was not referred to a tertiary centre prior to delivery.

No dilation 17%

Less than 18 mm 21%

18mm or greater

35%

Reported as dilated, but no measurement

given 4%

No dilation information

reported 17%

No ultrasound 6%

Not referred 5% Unknown

8%

Initial visit at 24 weeks or more

16%

Initial visit at less than 24

weeks 71%


GRAPH 1.4: GESTATIONAL AGE AT BIRTH

Gestational age is in complete weeks and calculated according to an algorithm in CNN, which considers both pediatric and obstetric estimates.

TABLE 1.5: ANTENATAL DELIVERY PLAN AS OF 32 WEEKS GESTATIONAL AGE

N %

No pre-determined plan 188 15%

Spontaneous vaginal delivery 366 29%

Elective Caesarean Section - Maternal Factors 57 5%

Elective Caesarean - Fetal Factors 47 4%

Induction 462 37%

Other 22 2%

Unknown 99 8%

*This table includes all pregnancy outcomes except terminations (n =1241)

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<30 30 31 32 33 34 35 36 37 38 39 40 >40

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Gestational Age


GRAPH 1.6: PROPORTION OF CAESAREAN SECTION GROUPED BY SITE - 2005 TO 2016

CAPSNet data reports delivery type in 3 categories: vaginal delivery, caesarean, and unknown. The percentage of caesarean section deliveries is presented below by site. The denominator for each year is the total number of GS cases where delivery type was reported. Note that years in which a site had zero reported cases were not included in the average calculation.

0%

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100%


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)

CAPSNet Site

Average 2005-2010Sites reporting lessthan 10 casesL

Average 2011-2016Sites reporting lessthan 10 cases


TABLE 1.7: TIMING OF GASTROSCHISIS CLOSURE

The denominator in this figure is the number of cases in which surgery was performed (n=1195).

Timing of Closure n %

< 6 hours 611 51%

6-12 hours 101 8%

12-24 hours 37 3%

> 24 hours 434 36%

Unknown 12 1%

GRAPH 1.8: SURGEON’S TREATMENT INTENT BY CENTRE

The denominator in this figure is the number of cases in which surgery was performed (n=1195). Across all centres, the surgeon’s treatment intent was to perform an urgent primary closure in 54% (n=643) of cases and elective primary closure (enabled by a silo) in 44% (n= 525). In the remaining 2% (n=27) of cases, the surgeon’s treatment intent is unknown. Across all centres, the surgeon’s treatment intent was to perform elective primary closure in 42% (n=258) of cases between 2005-2010 and 46% (n=267) of cases between 2011-2016. The CAPSNet definition of urgent primary closure is repair of the defect within 6 hours of NICU admission. Elective primary closure is delayed repair (>24 h) of the defect facilitated by silo placement. The percentage of cases where treatment intent was elective primary closure is shown below.

0%

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60%

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90%

100%


Pe

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s (

%)

CAPSNet Site

Average 2005-2010(Sites reportingfewer than 10cases L)

Average 2011-2016


2013-2016

FIGURE 1.9: METHOD OF SURGICAL CLOSURE CAPSNet data reports method of surgical closure in 7 categories: primary fascia, mass closure, umbilical cord flap closure, skin flap closure, biologic dressing*, and unknown. The percent of each closure type reported is presented below. The denominator for each time period is the total number of cases in which surgery was performed. Where DOB is unknown (n= 9), cases were grouped in the time period of 2005-2010. *Category added in 2012

FIGURE 1.9A: METHOD OF SURGICAL CLOSURE – 2005 TO 2010

`

FIGURE 1.9B: METHOD OF SURGICAL CLOSURE – 2011 TO 2016

Primary fascia 72%

Umbilical cord flap

11%

Mass closure

3%

Skin flap closure

7%

Unknown 7%

Primary fascia 54%

Umbilical cord flap

32%

Mass closure

1%

Skin flap closure

8%

Biologic dressing

1%

Other 1% Unknown

3%

Primary fascia 51%

Umbilical cord flap

36%

Mass closure

0%

Skin flap closure

8%

Biologic dressing

1%

Other 2% Unknown

2%


TABLE 1.10: OPERATIVE SUCCESS Of 1195 primary operations, 82% were recorded as successful. The 18% reported as failed initial closures were for the following reasons:

N %

Bowel not reducible 154 72%

Bowel would reduce, but IPP or PIP too high to close 16 8%

Bowel would reduce, but seemed too tight to close 32 15%

Unknown or missing 11 4%

FIGURE 1.11A: PROPORTIONAL GASTROSCHISIS PROGNOSTIC SCORE (GPS) SCORING

The GPS risk group is assigned based on the composite GPS score. For scores of <2, the patient is considered low risk (66%; n=806). Patients are considered as high risk for morbidity if their score is ≥ 2 while infants with scores ≥ 4 have a high risk for both morbidity and mortality. Of the patients at high risk (20%; n = 242), 73% are at a high risk for mortality (n = 177).

‘

Low risk 66%

Unknown/missing 14%

High risk morbidity and

mortality 15%

High risk morbidity only

5%

High risk, 20%


TABLE 1.11B: SELECTED NEONATAL OUTCOMES STRATIFIED BY GPS RISK

Indigenous GS Cases Non-Indigenous GS Cases All GS Cases

Length of Stay

TPN Days Days to Enteral Feeds

Length of Stay


Length of Stay


ALL CASES n=120 n=1092 n = 1212

Mean 59.8 44.2 17.7 58.3 43.5 17.0 58.4 43.6 17.1

Median 33 26 13 36 27 13 36 27 13

Range 4 - 626 4 - 433 0 - 102 0 - 747 0 - 603 0 - 215 0-747 0-603 0 – 215

LOW RISK

(GPS < 2) n=79

*2.5% (n=2) of low risk died n=727

*2.1% (n=15) of low risk died n =806

*2.1% (n=17) of low risk died

Mean 41.8 31.6 14.6 45.4 34.2 14.7 45.0 34.0 14.7

Median 32 25 12 33 25 12 33 25 13

Range 4 - 255 4 - 172 2 - 44 0 - 594 0 - 572 1 - 215 0 - 594 0 – 572 1-215

HIGH RISK: MORBIDITY

(GPS ≥ 2)

n=17 *0% (n=0) of subgroup died

n=225 *9.3% (n=21) of high risk died

n = 242 *8.7% (n=21) of high risk died

Mean 136.2 95.5 30 98.7 74.1 26.0 101.3 75.5 26.3

Median 105 50 20 65 50.0 18 66.5 50 18

Range 17 - 626 20 - 258 6 - 102 0 - 747 3 – 603 0 - 165 0-747 3 - 603 0-165

HIGH RISK: MORTALITY

(GPS ≥ 4)

subgroup of high risk group above: n=11

*0% (n=0) of subgroup died


(GPS ≥ 4)

subgroup of high risk group above: n=168

*11.3% (n=19) of subgroup died


(GPS ≥ 4)

subgroup of high risk group above: n = 179

*10.6% (n=19) of subgroup died

Mean 133.3 89.7 17.7 Mean 95.2 74.8 28 Mean 97.5 75.6 27.3

Median 71.0 50 11.5 Median 64 49 19 Median 64 49.5 19

Range 24 - 626 21 - 258 6 - 50 Range 0 - 747 0 - 603 0 - 165 Range 0-747 0 – 603 0-165


TABLE 1.12 A: SELECTED NEONATAL OUTCOMES STRATIFIED BY URGENT CLOSURE, DELAYED

CLOSURE AND CORD FLAP CLOSURE

TABLE 1.12 B: LOCATION OF CLOSURE STRATIFIED BY URGENT CLOSURE, DELAYED CLOSURE AND

CORD FLAP CLOSURE

Count

OR (Site of Closure)

All Cases 1212 66%

Urgent Closure 439 58%

Delayed Closure 338 77%

Cord flap closure 251 25%

Cord Flap Closure, Urgent Primary Closure (n=153)

OR (Site of Closure) 24%

Cord Flap Closure, Delayed Primary Closure (n=68)

OR (Site of Closure) 16%

GPS Length of

Stay TPN Days

Days to Enteral Feeds

ALL CASES (n=1212)

Mean 1.6 58.4 44.5 17.4

Median 1 36 27 13

Range 0-12 0-747 0-603 0-215

URGENT PRIMARY CLOSURE (n=612)

Mean 1.6 59.0 43.4 16.6

Median 1 34 25 12

Range 0-12 0-747 0-603 0-165

DELAYED PRIMARY CLOSURE (n=434)

Mean 1.6 58.2 45.2 18.6

Median 1 38 29 14.5

Range 0-11 3-430 3-410 0-145

CORD FLAP CLOSURE (n=251) n=153 Urgent closure; n=68 Delayed closure

Mean 1.1 51.6 39.5 18.0

Median 0 33 25 12

Range 0-10 10-430 8-276 3-215


GRAPH 1.13: SELECTED NEONATAL COMPLICATIONS

*For outcome definitions, please see appendix I

NECAbdominal

compartmentsyndrome

BowelObstruction

Chylothorax Line SepsisWound

InfectionTPN on

dischargeCholestasis

% 4% 2% 8% 0% 14% 11% 12% 18%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Pe

rce

nta

ge

of

ca

se

s (

%)


CONGENITAL DIAPHRAGMATIC HERNIA DESCRIPTIVE ANALYSES

TABLE 2.0: PATIENT POPULATION

Indigenous

live births

(n= 19)

Non-Indigenous live births

(n=677)

CDH complete live births

(n = 696)

Overall survival rate* 84.2% 79.6% 79.7%

Died without surgery 0.0% 13.0% 12.6%

Inborn rate 52.6% 58.2% 58.0%

Mean GA (weeks) 38 38 38

No prenatal diagnosis 26.3% 29.8% 29.7%

Mean birth weight (g) 3073.3 3042.5 3043.3

Mean age at repair (days) 6 6 6

Proportion of males 52.6% 57.9% 57.8%

Isolated defect** 42.1% 60.1% 59.6%

Proportion requiring ECMO 5.3% 6.6% 6.6%

Proportion with left-sided defect 68.4% 70.2% 70.1%

SNAP-II scores***

Recorded survivor scores

Recorded non- survivor scores

Mean – survivors

Mean – non-survivors

Median – survivors

Median – non-survivors

16

3

18.6

23.0

19.5

32

527

138

15.4

30.4

12

29

543

141

15.5

29.2

12.0

30.5

* Cases with a reported discharge destination as “home”, “hospital”, “other”, or “unknown” were grouped under survivors. **An isolated defect determined based on the absence of another congenital anomalies as entered in the CNN database. ***SNAP-II: Score for Neonatal Acute Physiology, version II. See Appendix I for definitions.


TABLE 2.1: SURVIVAL BY CENTRE VOLUME

This table shows the survival rate grouped by centre volume. Low volume centres are those that see on average <2 CDH cases per year, high volume centres see an average ≥ 5 CDH cases per year; and mid volume centres include all those in between.

Count (n) Survival (%)

SNAP-II Median

SNAP-II Range

High volume (4 centres) 387 81.4% 14 0-77

Mid volume (8 centres) 285 78.9% 16 0-68

Low volume (3 centres) 24 75.0% 15 0-53

FIGURE 2.2: MAXIMUM LUNG-HEAD RATIO (LHR)* LHR is measured during ultrasound interrogations for infants with a prenatal diagnosis of CDH. The data presented here reflects the best (i.e. greatest) measurement reported on any one ultrasound examination for the periods listed below:

1. First ultrasound taken at the tertiary CAPSNet centre; 2. Last ultrasound taken between 23+0 and 27+6 weeks; 3. Last ultrasound taken between 28+0 and 32+6 weeks; and 4. Last ultrasound before delivery

Not measured indicates that at least one ultrasound was recorded, but the lung-head ratio was not measured. *Since 2012, the CAPSNet database has had “embedded” calculators for both observed to expected lung-head ratio and observed to expected total fetal lung volume (for sites using fetal MRI). These values can be abstracted and used for antenatal counselling, even if the site does not report observed to expected lung growth indices.

Not measured 47%

No US 18%

Less than 1 6%

1 or greater 29%


FIGURE 2.3: EARLY VS. LATE INITIAL VISIT

Not referred means that the mother was not referred to a tertiary centre prior to delivery. Of the patients who were not referred prenatally (23%, n=161), 89% were not prenatally diagnosed (n=144).

GRAPH 2.4: GESTATIONAL AGE AT BIRTH

Gestational age is in complete weeks and calculated according to the CNN algorithm, which considers both pediatric and obstetric estimates.

Not referred 23%

Unknown 11%

Initial visit at less than 24

weeks 42%

Initial visit at 24 weeks or more

24%

0

20

40

60

80

100

120

140

160

180

<30 30 31 32 33 34 35 36 37 38 39 40 >40

Nu

mb

er

of

CD

H c

as

es

Gestational age at birth


GRAPH 2.5: PROPORTION OF CAESAREAN DELIVERY GROUPED BY SITE - 2005 TO 2016

CAPSNet data reports delivery type in 3 categories: vaginal delivery, caesarean and unknown. The percentage of caesarean section deliveries is presented below by site. The denominator for each year is the total number of CDH cases where delivery type was reported.

GRAPH 2.6: MEAN AGE AT SURGICAL REPAIR BY CENTRE

The denominator in this figure indicates only those cases in which surgery was performed and the date of surgery was recorded (i.e., n =572).

0%

10%

20%

30%

40%

50%

60%

70%


Pe

rce

nta

ge

of

ca

se

s (

%)

CAPSNet Site

Average 2005-2010Sites reporting lessthan 10 casesC, E, N

Average 2011-2016Sites reporting lessthan 10 casesE, N


Mean Days 9.31 6.27 6.50 0.61 7.40 6.43 6.81 4.22 6.46 3.33 1.00 5.00 7.90 4.52 7.41

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Me

an

nu

mb

er

of

da

ys


FIGURE 2.7: METHOD OF SURGICAL CLOSURE

GRAPH 2.8: SIZE OF CDH DEFECT

Starting in January 2010, CAPSNet added a variable to its data collection asking for the relative size of the CDH defect. The variable was not routinely reported for babies born prior to Jan 1, 2012; however, it is routinely reported in the new database for babies born from Jan 1, 2012 onwards. To date, 247 cases have this field filled out.

Primary 54%

Muscle flap 1%

Patch 26%

Unknown 3%

No repair 16%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

A B C D Unknown

Perc

en

tag

e o

f cases w

ith

de

fect

rep

ort

ed

(%

, n

=247)


GRAPH 2.9: SELECTED NEONATAL COMPLICATION

**For outcome definitions, please see appendix I

NECAbdominal

compartmentsyndrome

Bowelobstruction

Chylothorax Line sepsisWound

infectionTPN on

dischargeCDH

recurrence

% 2.6% 1.0% 1.3% 4.2% 5.9% 3.0% 4.6% 1.7%

0.0%

2.0%

4.0%

6.0%

8.0%

Pe

rec

en

tag

e o

f c

as

es

(%

)


GRAPH 2.10A: SELECTED NEONATAL OUTCOMES AT DISCHARGE

Tube Feeds: defined as any tube feed (G, J feeds) at discharge GER (Gastroesophageal Reflux): defined as a need for any anti-reflux medications at discharge CNS Injury: defined as a need for anticonvulsant medications at discharge Cholestatic liver disease: two or more consecutive measurements of 50 umol/l or greater conjugated bilirubin, over a period of at least 14 days immediately preceding discharge Oxygen Support: defined as a need for supplemental oxygen at discharge

TABLE 2.10B: SELECTED NEONATAL OUTCOMES

Indigenous live born survivors

(n=16)

Non-Indigenous live born survivors

(n=539)

All live born survivors

(n = 555)

Mean Median Range Mean Median Range Mean Median Range

Length of stay (days)

38.6 32 11-75 41.3 28 1-405 41.2 28 1-405

TPN days 21.2 19 9-40 21.2 16 1-184 21.2 16 1-184

Days to enteral feeds

9.3 8 2-31 10.4 8 0-63 10.4 8 0-63

Ventilation days (if required)

16.5 11 0-52 12.5 8 0-289 12.5 8 0-289

ECMO days (if required)

- - - 9.4 7.5 1-31 9.4 7.5 1-31

Supplemental O2 days (if required)

9.9 2 0-36 12.5 5 0-260 12.5 5 0-260

Tube Feed GERD CNS InjuryO2 at

dischargeCholestatic

Liver Disease

% 26% 29% 3% 16% 8%

0%

5%

10%

15%

20%

25%

30%

35%P

erc

en

tag

e o

f cases (

%)


APPENDIX I: DEFINITIONS ABDOMINAL COMPARTMENT SYNDROME: Defined as an increase in intra-abdominal pressure requiring surgery to relieve pressure. CAPSNET POPULATION DEFINITION: The CAPSNet database captures:

All cases of confirmed or suspect Congenital Diaphragmatic Hernia (CDH) and Gastroschisis (GS) diagnosed antenatally and referred to one of the participating tertiary perinatal centres for ongoing prenatal care of the fetus, regardless of the final outcome of pregnancy; and

All cases of CDH and GS diagnosed postnatally up to 7 days of life who were either born at or transferred after birth to one of the participating centres.

CHOLESTASIS/LIVER DISEASE: Defined as two or more consecutive measurements of 50 umol/l or greater of conjugated bilirubin, over a period of at least 14 days, with no documented bacteremia over that time period. CHYLOTHORAX: defined as: a pleural effusion with fluid triglyceride level >1mmol/l and /or white cell differential >90% lymphocytes appearing after CDH repair requiring treatment (usually chest tube placement). GASTROSCHISIS BOWEL DILATION: Refers to the maximum internal (i.e. endoluminal) diameter measured from inner wall to inner wall along the short axis of the bowel loop at the most dilated segment of the extruded bowel in millimeters (mm). GASTROSCHISIS BOWEL WALL THICKENING: Refers to the maximum bowel wall thickness measured from the inner wall to the outer wall of the thickest portion of the small bowel in millimeters (mm). LINE SEPSIS: Defined as documented bacteremia in the presence of an indwelling central line (PICC, percutaneous or surgically tunnelled) requiring antibiotics or line removal. LUNG (AREA) TO HEAD (CIRCUMFERENCE) RATIO (LHR): Refers to the measurement that reflects the severity of fetal pulmonary hypoplasia, and, if it has been measured, it will be reported as “lung to head ratio” or “LHR” within the ultrasound report. It is typically measured by a standardized technique, and reported (without units of measurement) for the lung on the side opposite of the diaphragmatic hernia (ie Right LHR will be reported for a left CDH). NECROTIZING ENTEROCOLITIS (NEC): Defined as the occurrence of impaired blood supply to portions of the bowel. This leads to small perforations with air dissecting in the bowel wall (pneumatosis) or even entering the peritoneal cavity (pneumoperitoneum). SNAP-II (SCORE FOR NEONATAL ACUTE PHYSIOLOGY): An illness severity scoring system which stratifies patients according to cumulative severity of physiologic derangement in several organ systems within the first 12 hrs of admission to the intensive care unit. This scoring system has been shown to be highly predictive of neonatal mortality and to be correlated with other indicators of illness severity including therapeutic intensity, physician estimates of mortality risk, length of stay, and nursing workload. SNAP provides a numeric score that reflects how sick each infant is. The scoring system is modeled after similar adult and pediatric scores, which are already widely in use. For more information, see: D K. Richardson et al . SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138: 92-100 If more than 65% of the SNAP score data elements were missing, SNAP-II scores cannot be computed and were thus excluded from any analyses.


APPENDIX II: LIST OF PUBLICATIONS, PRESENTATIONS AND

ONGOING PROJECTS

PUBLICATIONS 2018 Haddock C, Al Maawali AG, Ting J, Bedford J, Afshar K, and Skarsgard ED. Impact of

Multidisciplinary Standardization of Care for Gastroschisis: Treatment, Outcomes, and Cost. J Pediatr Surg. 7 Feb 2018; Online.

Skarsgard ED. The Value of Patient Registries in Advancing Pediatric Surgical Care. J Pediatr

Surg. 7 Feb 2018; Online.

Puligandla PS, Skarsgard ED, Offringa M, Adatia I, Baird R, Bailey M, Brindle M, Chiu P,

Cogswell A, Dakshinamurti S, Flageole H, Keijzer R, McMillan D, Oluyomi-Obi T, Pennaforte T, Perreault T, Piedboeuf B, Riley SP, Ryan G, Synnes A, and Traynor M. Diagnosis and Management of Congenital Diaphragmatic hernia: A Clinical Practice Guideline. CMAJ. 2018;190(4):E104-E112.

2017 Lally PA, and Skarsgard ED. Congenital diaphragmatic hernia: The role of multi-institutional

collaboration and patient registries in supporting best practice. Seminars in pediatric surgery. 2017;26(3):129-135.

Puligandla PS, Baird R, Skarsgard ED, Emil S, Laberge JM, and Canadian Pediatric Surgery

Network (CAPSNet). Outcome Prediction in Gastroschisis—The Gastroschisis Prognostic Score (GPS) revisited. J Pediatr Surg. 2017; 52(5):718-721.

Youssef F, Laberge JM, Puligandla P, Emil S, and Canadian Pediatric Surgery Network

(CAPSNet). Determinants of Outcomes in Patients with Simple Gastroschisis. J Pediatr Surg. 2017; 52(5):710-714.

2016 Bassil K, Yang J, Arbour L, Moineddin R, Brindle ME. The Canadian Pediatric Surgery Network

(CAPSNet). Spatial Variability of Gastroschisis in Canada, 2006-2011: An Exploratory Analysis. Can J Public Health. 2016;107(1):E62-E67.

Youssef F, Hsia L, Cheong A, Emil S, The Canadian Pediatric Surgery Network (CAPSNet).

Gastroschisis Outcomes in North America: A Comparison of Canada and the United States. J Pediatr Surg. 2016;51(6):891-895.

Youssef F, Gorgy A, Arbash G, Puligandla PS, and Baird RJ. Flap versus Fascial Closure for

Gastroschisis: A Systematic Review and Meta-analysis. J Pediatr Surg. 2016;51(5):718-725.

Puligandla P, Skarsgard ED. The Canadian Pediatric Surgery Network (CAPSNet) Congenital

Diaphragmatic Hernia Evidence Review Project: Developing National Guidelines for Care. Paediatr Child Health. 2016;21(4):183-186.


2015 Butler AE, Puligandla PS, Skarsgard ED. The Canadian Pediatric Surgery Network (CAPSNet):

Lessons Learned from a National Registry Devoted to the Study of Congenital Diaphragmatic Hernia and Gastroschisis. Eur J Pediatr Surg. 2015 Dec;25(6):474-80. doi: 10.1055/s-0035-1569477. Epub 2015 Dec 7.

Shariff F, Peters PA, Arbour L, Greenwood M, Skarsgard E, Brindle M, The Canadian Pediatric

Surgery Network (CAPSNet). Maternal and community predictors of gastroschisis and congenital diaphragmatic hernia in Canada. Pediatr Surg Int. 2015 Nov;31(11):1055-60.

Al-Kaff A, MacDonald SC, Kent N, Burrow J, Skarsgard E, Kent N, Hutcheon JA, The Canadian

Pediatric Surgery Network (CAPSNet). Delivery planning for pregnancies with gastroschisis: findings from a prospective national registry. Am J Obstet Gynecol. 2015 Oct;213(4):557.e1-8.

Beaumier CK, Beres AL, Puligandla PS, Skarsgard ED, The Canadian Pediatric Surgery

Network (CAPSNet). Clinical characteristics and outcomes of patients with Right Congenital Diaphragmatic Hernia: A population-based study. J Pediatr Surg. 2015 May;50(5):731-3.

Youssef F, Laberge JM, Baird R, The Canadian Pediatric Surgery Network (CAPSNet). The

Correlation Between Time Spent In Utero and Bowel Matting in Newborns with Gastroschisis. J Pediatr Surg. 2015 May;50(5):755-9.

Skarsgard ED, Meaney C, Bassil K, Brindle ME, Arbour L, Moineddin R, the Canadian Pediatric

Surgery Network (CAPSNet). Maternal Risk factors for Gastroschisis in Canada. Birth Def Res Part A 2015 Feb;103(2):111-8.

Emami C, Youssef F, Baird R, Laberge JM, Skarsgard ED, Puligandla PS, The Canadian

Pediatric Surgery Network (CAPSNet). A risk-stratified comparison of fascial versus flap closure techniques on the early outcomes of infants with gastroschisis. J Pediatr Surg 2015 Jan;50(1):102-6.

2014 Stanger J, Mohajerani N, Skarsgard ED, Canadian Pediatric Surgery Network. Practice

Variation in gastroschisis: Factors Influencing Closure Technique. J Pediatr Surg 2014 May; 49(5): 720-3.

Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B, Canadian Pediatric

Surgery Network. Outcome of patients with gastroschisis managed with and without multidisciplinary teams in Canada. Paediatr Child Health 2014 Mar; 19(3): 128-32.

2013 Alshehri A, Emil S, Laberge JM, Skarsgard E, Canadian Pediatric Surgery Network. Outcomes

of early versus late intestinal operations in patients with gastroschisis and intestinal atresia: results from a prospective national database. J Pediatr Surg 2013 Oct;48(10):2022-6.


Aljahdali A, Mohajerani N, Skarsgard ED, Canadian Pediatric Surgery Network. Effect of timing of enteral feeding on outcome in gastroschisis. J Pediatr Surg 2013 May;48(5):971-6.

Beres A, Puligandla PS, Brindle ME, Canadian Pediatric Surgery Network. Stability prior to surgery in Congenital Diaphragmatic Hernia: is it necessary? J Pediatr Surg 2013 May;48(5):919-23.

Goodwin Wilson M, Beres A , Baird R, Laberge J-M, Skarsgard ED, Puligandla PS, Canadian

Pediatric Surgery Network. Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility. J Pediatr Surg 2013 May;48(5):924-9.

Maxwell D, Baird R, Puligandla P, the Canadian Pediatric Surgery Network. Abdominal closure in neonates after congenital diaphragmatic hernia. J Pediatr Surg 2013 May;48(5):930-4.

Nasr A, Ryan G, Bass J, Langer J, Canadian Pediatric Surgery Network. Effect of delivery

philosophy on outcome in fetuses with gastroschisis. J Pediatr Surg 2013 Nov;48(11):2251-5.

2012 Akhtar J, Skarsgard ED; Canadian Pediatric Surgery Network. Associated Malformations and

the “Hidden Mortality” of Gastroschisis. J Pediatr Surg 2012 May;47(5):911-6. Nasr A, Langer JC; Canadian Pediatric Surgery Network. Influence of location of delivery on

outcome in neonates with gastroschisis. J Pediatr Surg 2012 Nov;47(11):2022-5. Baird R, Puligandla P, Skarsgard ED, Laberge JM; Canadian Pediatric Surgery Network.

Infectious complications in Gastroschisis: A CAPSNet Study. Pediatr Surg Int 2012 Apr;28(4):399-404.

Brindle ME, Flageole H, Wales PW. Influence Of Maternal Factors And Aboriginal Status On

Health Outcomes In Gastroschisis: A Canadian Population-based Study. Neonatology 2012;102(1):45-52.

Cowan KN, Puligandla PS, Laberge JM, Skarsgard ED, Bouchard S, Yanchar N, Kim P, Lee

SK, McMillan D, von Dadelszen P, and the Canadian Pediatric Surgery Network. The Gastroschisis Prognostic Score: Outcome prediction in Gastroschisis. J Pediatr Surg 2012 Jun;47(6):1111-7.

Jansen LA, Safavi A, Lin Y, MacNab YC, Skarsgard ED; and the Canadian Pediatric Surgery

Network. Pre-closure Fluid Resuscitation Influences Outcome in Gastroschisis. Am J Perinatol 2012 Apr;29(4):307-12.

Mills J, Safavi A, Skarsgard ED; Canadian Pediatric Surgery Network. Chylothorax Following

Congenital Diaphragmatic Hernia Repair: A Population-based Study. J Pediatr Surg 2012 May;47(5):842-6.

Safavi A, Skarsgard ED, Butterworth SA; Canadian Pediatric Surgery Network. Bowel Defect


Disproportion in Gastroschisis: Does the need to extend the fascial defect predict outcome? Pediatr Surg Int 2012 May;28(5):495-500.

Safavi A, Synnes AR, O’Brien KK, Chiang M, Skarsgard ED, Chiu P; Canadian Pediatric

Surgery Network. Multi-institutional follow up of congenital diaphragmatic hernia (CDH) patients reveals severe disability and variations in practice. J Pediatr Surg 2012 May;47(5):836-41

Van Manene M, Bratu I, Narvey M, Rosychuk RJ; Canadian Pediatric Surgery Network. Use of paralysis in silo-assisted closure of gastroschisis. J Pediatr 2012 Jul;161(1):125-8.

2011 Baird R, Eeson G, Safavi A, Puligandla P, Laberge JM, Skarsgard ED; Canadian Pediatric

Surgery Network. Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network. J Pediatr Surg 2011 May;46(5):801-7.

Brindle ME, Brar M, Skarsgard ED; and the Canadian Pediatric Surgery Network (CAPSNet).

Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia. Pediatr Surg Int 2011 Sep;27(9):969-74. Epub 2011 May 18.

Nasr A, Langer JC; Canadian Pediatric Surgery Network. Influence of location of delivery on

outcome in neonates with congenital diaphragmatic hernia. J Pediatr Surg 2011 May;46(5):814-6.

2010 Brindle ME, Ma IWY, Skarsgard ED. Impact of target blood gases on outcome in congenital

diaphragmatic hernia (CDH). Eur J Pediatr Surg 2010 Sep;20(5):290-3. Mills JA, Lin Y, MacNab YC, Skarsgard ED and the Canadian Pediatric Surgery Network. Does

overnight birth influence treatment or outcome in Congenital Diaphragmatic Hernia? Am J of Perinatol 2010; 27 (1): 91-95.

Mills J, Lin Y, MacNab Y, Skarsgard ED JM and the Canadian Pediatric Surgery Network.

Perinatal predictors of outcome in gastroschisis. J Perinatol 2010 Dec;30(12):809-13. Safavi A, Lin Y, Skarsgard ED; Canadian Pediatric Surgery Network. Perinatal management of

congenital diaphragmatic hernia: when and how should babies be delivered? Results from the Canadian Pediatric Surgery Network. J Pediatr Surg 2010 Dec;45(12):2334-9.

2009 Boutros J, Regier M, Skarsgard ED and the Canadian Pediatric Surgery Network. Is timing

everything? The influence of gestational age and intended and actual route of delivery on treatment and outcome in Gastroschisis. J Pediatr Surg 2009; 44:912-7.

Grushka JR, Laberge JM, Puligandla P, Skarsgard ED and the Canadian Pediatric Surgery

Network. The effect of hospital case volume on outcome in Congenital Diaphragmatic Hernia. J Pediatr Surg 2009; 44:873-6.

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Langer%20JC%22%5BAuthor%5D


2008 Skarsgard ED, Claydon J, Bouchard S, Kim P, Lee SK, Laberge JM, McMillan D, von

Dadelszen P, Yanchar N and the Canadian Pediatric Surgery Network. Canadian Pediatric Surgical Network: a population-based pediatric surgery network and database for analyzing surgical birth defects: The first 100 cases of gastroschisis. J Pediatr Surg 2008; 43(1):30-4.

Baird R, MacNab YC, Skarsgard ED, and the Canadian Pediatric Surgery Network. Mortality

prediction in congenital diaphragmatic hernia. J Pediatr Surg 2008;43(5):783-7. Weinsheimer RL, Yanchar NL, Bouchard S, Kim P, Laberge JM, Skarsgard ED, Lee SK,

McMillan D, von Dadelszen P, and the Canadian Pediatric Surgery Network. Gastroschisis closure – does method really matter? J Pediatr Surg 2008;43(5):874-8.

Weinsheimer RL, Yanchar NL and the Canadian Pediatric Surgical Network. Impact of maternal

substance abuse and smoking on children with Gastroschisis. J Pediatr Surg 2008; 43(5):879-83.

2006 Skarsgard E. Networks in Canadian pediatric surgery: Time to get connected. Paediatr Child

Health 2006; 11(1):15-18.


CONFERENCE PROCEEDINGS 2017 Skarsgard ED. CAPSNet CDH Network. Presented at the International CDH Symposium,

Liverpool, UK. November 15, 2017. Baird R, Puligandla P, and The Canadian Congenital Diaphragmatic Hernia Collaborative.

National Management Guidelines for the Care of Infants with Congenital Diaphragmatic Hernia. Presented at the 49th Annual Meeting of the Canadian Association of Pediatric Surgeons, Banff, AB. October 5, 2017.

Haddock C, Almaawali A, Skarsgard ED. Gastroschisis Treatment and Outcomes Before and

After Multidisciplinary Care Standardization. 49th Annual Meeting of the Canadian Association of Pediatric Surgeons. Banff, AB. October 6, 2017.

2016 Puligandla P. Value Proposition of Pediatric Surgical Registries: The Canadian Pediatric

Surgery Network (CAPSNet). Presented at the World Federation of the Associations of Pediatric Surgeons (WOFAPS) Meeting, Washington, DC. October 9, 2016

Puligandla PS, Baird R, Skarsgard ED, Emil S, Laberge JM, and the Canadian Pediatric

Surgery Network (CAPSNet). Outcome Prediction in Gastroschisis – The Gastroschisis Prognostic Score (GPS) Revisited. Presented at the 48th Annual Meeting of the Canadian Association of Pediatric Surgeons, Vancouver, BC. September 23, 2016.

Yousse F, Laberge J-M, Puligandla P, and Emil S. The Canadian Pediatric Surgery Network. Determinants of Outcomes in Patients with Simple Gastroschisis. Presented at the 48th Annual Meeting of the Canadian Association of Pediatric Surgeons, Vancouver, BC. September 23, 2016

Skarsgard ED. The Canadian Pediatric Surgery Network (CAPSNet): Learnings from a National

CDH Registry. Presented at the Canadian National Perinatal Research Meeting, Banff, AB. February 12, 2016.

2015 Youssef F, Hsia L, Cheong A, and Emil S. Gastroschisis Outcomes in North America: A

Comparison of Canada and the United States. Presented at the American Academy of Pediatrics National Conference & Exhibition, Washington, DC. Oct. 25, 2015.

Baird R, Pandya K, and Puligandla P. A propensity-matched analysis of inhaled nitric oxide for

congenital diaphragmatic hernia. Presented at the 47th Annual Meeting of the Canadian Association of Pediatric Surgeons, Niagara Falls, ON. September 17-19, 2015.

Skarsgard ED. CAPSNet: The First 10 Years. Presented at the 2015 International Congenital

Diaphragmatic Workshop. Toronto, ON. September 15, 2015. Thomas S, Laberge JM, Baird R, Lalous M, and Skarsgard E. The factors associated with

elective termination of pregnancy of fetuses with congenital diaphragmatic hernia. Presented at the 46th Annual Meeting of the American Pediatric Surgical Association, Fort Lauderdale, Florida. April 30-May 3, 2015.


2014 Shariff F, Skarsgard E, Arbor L, Bassil K, Brindle M. Gastroschisis communities in Canada: A

population-based analysis of community and personal risk factors. Presented at the 46th Annual Meeting of the Canadian Association of Pediatric Surgeons, Montreal, QC. Sept. 18-20, 2014.

Beaumier C, Beres A, Puligandla P, Skarsgard E. Clinical characteristics and outcomes of

patients with right congenital diaphragmatic hernia: A population based study. Presented at the 46th Annual Meeting of the Canadian Association of Pediatric Surgeons, Montreal, QC. Sept. 18-20, 2014.

Petropoulos T, Brindle M, Chiu P, Lapidus-Krol E. The Management Of Severe

Gastroesophageal Reflux Disease (GERD) In Congenital Diaphragmatic Hernia (CDH) Patients: A CAPSnet Review Of Current Practices. Presented at the 46th Annual Meeting of the Canadian Association of Pediatric Surgeons, Montreal, QC. Sept. 18-20, 2014.

Youssef F, Laberge JM, Baird R. The Correlation Between Time Spent In Utero and Bowel

Matting in Newborns with Gastroschisis. Presented at the 46th Annual Meeting of the Canadian Association of Pediatric Surgeons, Montreal, QC. Sept. 18-20, 2014.

Laberge JM, Baird R, Lalous M, and Sarath S. The relationship between LHR, prognosis and

TAB rates in fetuses with CDH based on CAPSNet data from 2005-2013. Presented at the 33rd Annual Conference of the International Fetal Medicine and Surgery Society, Chatham, Massachusetts, USA. Sept. 7-11, 2014.

Al-Kaff A, Hutcheon JA, Burrow J, Skarsgard E, Kent N. The impact of delivery planning on

neonatal outcome for fetuses with gastroschisis: findings from a national registry. Presented at the Annual Clinical Meeting of the Society of Obstetricians and Gynaecologists of Canada, Niagara, ON. June 2014.

Emami C, Youssef F, Puligandla P, and Baird R. A risk-stratified comparison of fascial versus

flap closure techniques on early outcomes of infants with gastroschisis. Presented at the 45th Annual Meeting of the American Pediatric Surgery Association, Phoenix, Arizona, USA. May 29-June 1, 2014.

2013 Stanger J, Mohajerani N, Skarsgard ED, Canadian Pediatric Surgery Network. Practice

Variation in gastroschisis: Factors Influencing Closure Technique. Presented at the 45th Annual Meeting of the Canadian Association of Pediatric Surgeons, Charlottetown, PEI. Sept 26-28, 2013.

2012 Yanchar N, Canadian Pediatric Surgery Network. CAPSNet – The Past, Present, and Future.

Presented at the 13th EUPSA Congress and 59th BAPS Congress, Rome, Italy. June 13-16, 2012.

Aljahdali A, Mohajerani N, Skarsgard ED, Canadian Pediatric Surgery Network. Effect of timing

of enteral feeding on outcome in gastroschisis. Presented at the 44th Annual Meeting of the Canadian Association of Pediatric Surgeons, Victoria, Canada. Sept 20-22, 2012.


Beres A, Puligandla PS, Brindle ME, Canadian Pediatric Surgery Network. Conformity to

stability criteria for the surgical correction of congenital diaphragmatic hernia: Is it necessary? Presented at the 44th Annual Meeting of the Canadian Association of Pediatric Surgeons, Victoria, Canada. Sept 20-22, 2012.

Goodwin WM, Beres A , Baird R, Laberge J-M, Skarsgard ED, Puligandla PS, Canadian Pediatric Surgery Network. Congenital diaphragmatic hernia (CDH) mortality without surgical repair? A plea to clarify surgical ineligibility. Presented at the 44th Annual Meeting of the Canadian Association of Pediatric Surgeons, Victoria, Canada. Sept 20-22, 2012.

Hazell A, Bassil K, Arbour L, Brindle M, Skarsgard E, Canadian Pediatric Surgery Network.

Geographic variation and clustering of gastroschisis in Canada. Presented at the 39th ICBDSR and 10th CCASN Joint Annual Scientific Meeting, 2012, Ottawa, Canada. Oct 30th – Nov 2nd, 2012.

Laberge J-M. Primero Curso Internacional de Actualizacion en Ginecologia y Perinatalogia

(First update course in gynecology and perinatalogy) Hospital Alcivar, Guayaquil, Ecuador, July 12-14 2012.

Laberge, J-M. Hernia diafragmática congénita. Resultados Canadienses y la implicación de la

oclusión traqueal fetal (CDH: Canadian results and the role of fetal tracheal occlusion). Laberge, J-M . El resultado de la Red Canadiense de Cirugía pediátrica en el manejo de

Gastroquisis. (Results from the Canadian Paediatric Surgery Network in the management of gastroschisis).

Maxwell D, Puligandla P, Baird R, the Canadian Pediatric Surgery Network. Abdominal closure

in neonates with congenital diaphragmatic hernia. Presented at the 44th Annual Meeting of the Canadian Association of Pediatric Surgeons, Victoria, Canada. Sept 20-22, 2012.

Nasr A, Ryan G, Bass J, Langer J, Canadian Pediatric Surgery Network. Effect of delivery

approach on outcome in fetuses with gastroschisis. Presented at the 44th Annual Meeting of the Canadian Association of Pediatric Surgeons, Victoria, Canada. Sept 20-22, 2012.

Skarsgard E. Collaborative Outcome Improvement in Canadian Pediatric Surgery. Presented

at the 2012 Canadian Association of Pediatric Health Centres (CAPHC) Annual Meeting. Vancouver, Canada. October 28, 2012.

2011 Nasr A, Langer JC; Canadian Pediatric Surgery Network. Influence of Location of Delivery on

Outcome of Neonates with Gastroschisis. Presented at the 42nd Annual Meeting of the American Pediatric Surgical Association, Palm Springs, CA. May 22-25, 2011.

Akhtar J, Skarsgard ED; Canadian Pediatric Surgery Network. Associated Malformations and

the “Hidden Mortality” of Gastroschisis. Presented at the 43rd Annual Meeting of the Canadian Association of Pediatric Surgeons, Ottawa, Canada. Sept 22-25, 2011.


Safavi A, Skarsgard ED; Canadian Pediatric Surgery Network. Antenatal Ultrasound Predictors

of Bowel Injury in Gastroschisis. Presented at the 43rd Annual Meeting of the Canadian Association of Pediatric Surgeons, Ottawa, Canada. Sept 22-25, 2011.

Mills J, Safavi A, Skarsgard ED; Canadian Pediatric Surgery Network. Chylothorax Following

Congenital Diaphragmatic Hernia Repair: A Population-based Study. Presented at the 43rd Annual Meeting of the Canadian Association of Pediatric Surgeons, Ottawa, Canada. Sept 22-25, 2011.

Brindle ME, Flageole H, Wales PW. Influence Of Maternal Factors And Aboriginal Status On

Health Outcomes In Gastroschisis: A Canadian Population-based Study. A Population-based Study. Presented at the 43rd Annual Meeting of the Canadian Association of Pediatric Surgeons, Ottawa, Canada. Sept 22-25, 2011.

Moore AM, Madhoo P, Himidan S, Ryan G, Skarsgard ED; Canadian Pediatric Surgery

Network. Examining the Hidden Mortality of Congenital Diaphragmatic Hernia. Presented at the 52nd Annual Meeting of the European Society for Pediatric Research, Newcastle, UK. October 14-17, 2011.

Moore AM, Madhoo P, Himidan S, Ryan G, Skarsgard ED; Canadian Pediatric Surgery Network. Health Care Utilisation for Pregnancies Complicated by Fetal Gastroschisis. Presented at the 88th Annual Meeting of the Canadian Pediatric Society, June 15-18, 2011. Quebec City, CA.

Safavi A, Synnes AR, O’Brien KK, Chiang M, Skarsgard ED, Chiu P; Canadian Pediatric

Surgery Network. Multi-institutional follow up of congenital diaphragmatic hernia (CDH) patients reveals severe disability and variations in practice. Presented at the 43rd Annual Meeting of the Canadian Association of Pediatric Surgeons, Ottawa, Canada. Sept 22-25, 2011.

Cowan KN, Puligandla PS, Laberge JM, Skarsgard ED, Butter A, Bouchard S, Yanchar N, Kim P, Lee SK, McMillan D, von Dadelszen P and the Canadian Pediatric Surgery Network. The gastroschisis bowel score predicts outcome in gastroschisis (updated numbers). Presented at the Surgical Section of the American Academy of Pediatrics, NCE, Boston MA. October 15-18, 2011.

2010 Laberge JM and the Canadian Pediatric Surgery Network. Congenital Diaphragmatic Hernia:

Results and factors affecting outcomes in the Canadian Pediatric Surgery Network. Presented at the 3rd World Congress of Pediatric Surgery; New Delhi, India. October 21-24, 2010.

Eeson G, Safavi A, Skarsgard E, and the Canadian Pediatric Surgery Network. Practice and

outcome variation in CDH in Canada. Presented at the 42nd annual meeting of the Canadian Association of Pediatric Surgeons; Saskatoon, Saskatchewan. September 23-28, 2010.


Nasr A, Langer JC and the Canadian Pediatric Surgery Network. Influence of location of delivery on outcome in neonates with congenital diaphragmatic hernia. Presented at the 42nd annual meeting of the Canadian Association of Pediatric Surgeons; Saskatoon, Saskatchewan. September 23-28, 2010.

Baird R, Puligandla, Laberge JM and the Canadian Pediatric Surgery Network. Practice and

outcome variation in Gastroschisis in Canada. Presented at the 42nd annual meeting of the Canadian Association of Pediatric Surgeons; Saskatoon, Saskatchewan. September 23-28, 2010.

Safavi A, Lin Y, Skarsgard ED and the Canadian Pediatric Surgery Network. Perinatal

management of congenital diaphragmatic hernia: When and how should babies be delivered? Presented at the 43rd Annual Meeting of the Pacific Association of Pediatric Surgeons; Kobe, Japan. May 23-27, 2010.

Wilson D and the Canadian Pediatric Surgery Network. The Canadian Pediatric Surgery

Network (CAPSNet): Targeting national outcome improvement for structural birth defects through collaborative knowledge synthesis and evidence-based practice change. Presented at the 18th Annual Western Perinatal Research Meeting; Banff, Alberta. February 11-14, 2010.

Jansen L, Lin Y, MacNab Y, Skarsgard ED, Puligandla PS and the Canadian Pediatric Surgery Network. Pre-closure fluid resuscitation influences outcome in gastroschisis. Presented at the 41st Annual Meeting of the American Pediatric Surgical Association; Orlando, Florida. May 16-19, 2010.

Cowan KN, Puligandla PS, Laberge JM, Skarsgard ED, Butter A, Bouchard S, Yanchar N, Kim

P, Lee SK, McMillan D, von Dadelszen P and the Canadian Pediatric Surgery Network. The gastroschisis bowel score predicts outcome in gastroschisis. Poster presented at the 2010 Annual Meeting of the Pediatric Academic Societies; Vancouver BC. May 1-4, 2010.

Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B and the Canadian

Pediatric Surgery Network. Does a multidisciplinary team improve outcome of gastroschisis patients? Poster presented at the 2010 Annual Meeting of the Pediatric Academic Societies; Vancouver BC. May 1-4, 2010.

Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B and the Canadian

Pediatric Surgery Network. Early stratification of gastroschisis patients: Are we there yet? Poster presented at the 2010 Annual Meeting of the Pediatric Academic Societies; Vancouver BC. May 1-4, 2010.

2009 Cowan KN, Puligandla PS, Bütter A, Skarsgard ED, Laberge JM and the Canadian Pediatric

Surgery Network. The Gastroschisis Bowel Score Predicts Outcome in Gastroschisis. Presented at the 4th Annual Academic Surgical Congress; Fort Myers, Florida. Feb 2009.

Baird R, Skarsgard ED, Laberge J-M, Puligandla PS, and the Canadian Pediatric Surgical

Network. The Use of Antibiotics in the Management of Gastroschisis-Canadian Practice


Patterns. Presented at the 40th Annual Meeting of the American Pediatric Surgical Association; Fajardo, Puerto Rico. May 28-30, 2009.

Brindle M, Ma IW, Skarsgard ED and The Canadian Pediatric Surgery Network. Impact of

Target Blood Gases on Outcome in Congenital Diaphragmatic Hernia (CDH). Presented at the 40th Annual Meeting of the American Pediatric Surgical Association; Fajardo, Puerto Rico. May 28-30, 2009.

Brindle M, Oddone E, Skarsgard ED and The Canadian Pediatric Surgery Network. Need for

Patch Repair Influences Outcome in Congenital Diaphragmatic Hernia (CDH). Presented at the 40th Annual Meeting of the American Pediatric Surgical Association; Fajardo, Puerto Rico. May 28-30, 2009.

Mills J, Lin Y, MacNab Y, Skarsgard ED JM and the Canadian Pediatric Surgery Network.

Perinatal Predictors of Outcome in Gastroschisis. Presented at the 40th Annual Meeting of the American Pediatric Surgical Association; Fajardo, Puerto Rico. May 28-30, 2009.


Network. The Effect of Prenatal Diagnosis on the Contemporary Outcome of CDH. Presented at the 40th Annual Meeting of the American Pediatric Surgical Association; Fajardo, Puerto Rico. May 28-30, 2009.

Butterworth SA, Brant R, Skarsgard ED and the Canadian Pediatric Surgery Network. Is the

need for fascial defect extension a predictor of adverse outcome in gastroschisis? Presented at the 41st Annual meeting of the Canadian Pediatric Surgery Association; Halifax, Nova Scotia. October 1-4, 2009.

2008 Mills J, MacNab Y, Skarsgard ED and the Canadian Pediatric Surgery Network. Does Overnight

Birth Time Influence Surgical Management of Outcome in Neonates with Gastroschisis? Presented at the 79th Annual Meeting of the Pacific Coast Surgical Association; San Diego, California. Feb 16, 2008.

Brindle M, Mills J,Lin Y, MacNab Y, Skarsgard ED and the Canadian Pediatric Surgery Network.

Influence of Birth Time on Surgical Management and Outcomes of Neonates with Gastroschisis. Presented at the 2008 Joint Meeting of the Pediatric Academic Societies and the Society for Pediatric Research. Honolulu, HI, May 2008.

Pressey TP, Skarsgard ED, Claydon J, von Dadelszen P, and the Canadian Pediatric Surgery

Network. Antenatal Ultrasound Detection of Abnormal Amniotic Fluid Volume Predicts Adverse Perinatal Outcomes. Presented at the 14th International Conference on Prenatal Diagnosis and Therapy. Vancouver, Canada, June 2008.

Laberge JM, Skarsgard ED and the Canadian Pediatric Surgical Network. CAPSNET: The

Canadian Pediatric Surgical Network. Presented at the Pan-African Pediatric Surgical Association Meeting; Ghana, Africa: August 14-22, 2008.


Laberge JM and the Canadian Pediatric Surgery Network. Contemporary outcome of CDH: Results from the Canadian Pediatric Surgery Network (CAPSNet). Presented at the International Fetal Medical and Surgical Society (IFMSS), Athens, Greece, September 11-14, 2008.

Boutros J, Regier M, Skarsgard ED and the Canadian Pediatric Surgery Network. Is timing

everything? The influence of gestational age and intended and actual route of delivery on treatment & outcome in Gastroschisis. Presented at the 2008 Annual Meeting of the Canadian Association of Pediatric Surgeons. Toronto, Canada, September 2008.


Network. The effect of hospital case volume on outcome in Congenital Diaphragmatic Hernia. Presented at the 2008 Annual Meeting of the Canadian Association of Pediatric Surgeons. Toronto, Canada, September 2008.

2007 Baird R, MacNab YC, Skarsgard ED, and the Canadian Pediatric Surgery Network. Mortality

prediction in congenital diaphragmatic hernia. Presented at the 2007 Annual Canadian Association of Pediatric Surgeons Meeting; St. John’s, Newfoundland. Aug 25, 2007.

Skarsgard ED, Claydon J, Bouchard S, Kim P, Lee SK, Laberge JM, McMillan D, von

Dadelszen P, Yanchar N and the Canadian Pediatric Surgery Network. Canadian Pediatric Surgical Network: a population-based pediatric surgery network and database for analyzing surgical birth defects: The first 100 cases of gastroschisis. Presented at the 38th Annual Meeting of the American Pediatric Surgical Association. May 2007. Also presented at the 26th Annual Meeting of the International Fetal Medicine and Surgery Society. Apr 30, 2007, Aruba.

Pressey TP, Skarsgard ED, Claydon J, von Dadelszen P and the Canadian Pediatric Surgery

Network. Ultrasound Predictors of Outcome in Antenatally Diagnosed Gastroschisis. Presented at the 26th Annual Meeting of the International Fetal Medicine and Surgery Society. Apr 30, 2007, Aruba.

Weinsheimer RL, Yanchar NL, Bouchard S, Kim P, Laberge JM, Skarsgard ED, Lee SK,

McMillan D, von Dadelszen P, and the Canadian Pediatric Surgery Network. Gastroschisis Closure – Does Method Really Matter? Presented at the 2007 Annual Canadian Association of Pediatric Surgeons Meeting; St. John’s, Newfoundland. Aug 25, 2007.

Weinsheimer RL, Yanchar NL and the Canadian Pediatric Surgical Network. Impact of Maternal

Substance Abuse and Smoking on Children with Gastroschisis. Presented at the 2007 Annual Canadian Association of Pediatric Surgeons Meeting; St. John’s, Newfoundland. Aug 25, 2007.


ADDITIONAL ONGOING PROJECTS

Benjamin Allin, Erik Skarsgard, and Marian Knight. Next Stage in Evidence-based paediatric surgical Treatment Strategies 2 – Outcomes from an international cohort of infants born with gastroschisis Pramod Puligandla, Kathryn LaRusso. The Congenital Diaphragmatic Hernia Collaborative: Strategy for the Implementation of Evidence and Consensus-Based Clinical Management Guidelines

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