. 2022 Nov 18;fetalneonatal-2022-324415.

 doi: 10.1136/archdischild-2022-324415. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36400455/

Respiratory function after birth in infants with congenital diaphragmatic hernia

K Taylor Wild ¹, Leny Mathew ², Holly L Hedrick ^3 4, Natalie E Rintoul ^5 4, Anne Ades ^5 4, Leane Soorikian ⁵, Kelle Matthews ⁵, Michael A Posencheg ^5 4, Erin Kesler ³, K Taylor Van Hoose ³, Howard B Panitch ^4 6, John Flibotte ^5 4, Elizabeth E Foglia ^5 4

Affiliations expand

• PMID: 36400455
• DOI: 10.1136/archdischild-2022-324415

Abstract

Objective: To characterise the transitional pulmonary physiology of infants with congenital diaphragmatic hernia (CDH) using measures of expiratory tidal volume (TV) and end-tidal carbon dioxide (ETCO₂).

Design: Prospective single-centre observational study.

Setting: Quaternary neonatal intensive care unit.

Patients: Infants with an antenatal diagnosis of CDH born at the Children’s Hospital of Philadelphia.

Interventions: TV and ETCO₂ were simultaneously recorded using a respiratory function monitor (RFM) during invasive positive pressure ventilation immediately after birth.

Main outcome measures: TV per birth weight and ETCO₂ values were summarised for each minute after birth. Subgroups of interest were defined by liver position (thoracic vs abdominal) and extracorporeal membrane oxygenation (ECMO) treatment.

Results: RFM data were available for 50 infants from intubation until a median (IQR) of 9 (7-14) min after birth. TV and ETCO₂ values increased for the first 10 min after birth, but intersubject values were heterogeneous. TVs were overall lower and ETCO₂ values higher in infants with an intrathoracic liver and infants who were ultimately treated with ECMO. On hospital discharge, survival was 88% (n=43) and 34% (n=17) of infants were treated with ECMO.

Conclusion: Respiratory function immediately after birth is heterogeneous for infants with CDH. Lung aeration, as evidenced by expired TV and ETCO₂, appears to be ongoing throughout the first 10 min after birth during invasive positive pressure ventilation. Close attention to expired TV and ETCO₂ levels by 10 min after birth may provide an opportunity to optimise and individualise ventilatory support for this high-risk population.

Keywords: neonatology; resuscitation.

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