Talbert lecture features expert in congenital diaphragmatic hernia treatment

Charles J.H. Stolar, M.D., surgeon-in-chief and director of pediatric surgery at Morgan Stanley Children’s Hospital, Columbia University Medical Center, was this year’s guest speaker at The James Lewis Talbert Lectureship and Mini-Symposium Program on March 25.

Talbert, a professor emeritus and founding chief of the division of pediatric surgery, joined the University of Florida College of Medicine in 1967.

Stolar’s lecture, titled “Congenital Diaphragmatic Hernia: Infants Becoming Adolescents and Young Adults,” described the great progress he and his colleagues have made in treating infants with diaphragmatic hernia over the past several decades.

“When I finished my fellowship (at the Children’s National Medical Fellowship in Washington, D.C. in 1982), I had never seen a baby with this diagnosis survive,” Stolar recalled.

Today, he said, the survival rate for babies with diaphragmatic hernia (CDH) born at Morgan Stanley Children’s Hospital, Columbia University Medical Center, is about 82 percent. Nationwide, the survival rate is about 60 percent, estimated David Kays, M.D., an associate professor and chief of the division of pediatric surgery in UF’s College of Medicine. He specializes in treating CDH.

Stolar attributed the dramatic increase in survival rates to improved procedures and treatment methods, including more sparing use of extracorporeal membrane oxygenation (ECMO), a type of heart-lung bypass machine often used in CDH treatments; as well as the practice of waiting a few days to operate on newborn CDH patients so they can grow stronger.

Stolar and his colleagues pioneered many of these changes, which are becoming more widespread at hospitals nationwide.

Kays studied under Stolar during a fellowship at Columbia University and has implemented what he learned there in his practice at Shands at UF Children’s Hospital. “Since I’ve been here, we’ve taken care of over 260 congenital diaphragmatic hernia patients with an overall survival that exceeds 80 percent,” Kays said in an interview before the lecture.

Now that many children are surviving CDH diagnoses, Stolar said the medical community is just beginning to understand how the condition can affect growth through early childhood and the teenage years.

Doctors now know to look for signs a young CDH patient is developing scoliosis or pectus excavatum as a result of an abnormal diaphragm. Stolar said CDH patients also can suffer from iatrogenic lung disease, digestive problems, esophagitis, neurocognitive/neuromotor impairment and other side effects. Specialists in CDH continue to address these problems and look for ways to make them less prevalent in patients.

Kays watches for all these conditions, and others in his patients, and said he encourages them to see him for check-ups until they reach college age.

He said children born with cases of CDH that are not severe — about 50 percent of all CDH patients — will not experience complications as they grow.

“They are going to be just normal and you’re not really going to be able to find much of anything,” Kays said.