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Research: Impact of a standardized management guideline for infants with CDH: A single-center experience

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Research: Impact of a standardized management guideline for infants with CDH: A single-center experience

J Pediatr Surg

. 2022 Aug 1;S0022-3468(22)00499-7.

 doi: 10.1016/j.jpedsurg.2022.07.022. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/35965150/

Impact of a standardized management guideline for infants with CDH: A single-center experience

Katrin Lichtsinn 1Paul K Waltz 2Abeer Azzuqa 3Joseph Church 2Jacqueline Graham 3Jennifer Troutman 3Burhan Mahmood 3

Affiliations expand

Abstract

Background: Infants with congenital diaphragmatic hernia (CDH) are at high risk of death, even despite extracorporeal membrane oxygenation (ECMO) support. In January 2012 we implemented a standardized clinical practice guideline (CPG) to manage infants with CDH. We hypothesized that infants with CDH managed with CPG had better clinical outcomes, less ECMO utilization, and increased survival to discharge.

Methods: We conducted a retrospective pre-post study of infants with CDH admitted between January 2007 and July 2021 (n = 133). Patients were divided into Cohort 1, pre-CPG (January 2007 to December 2011, n = 54), and Cohort 2, post-CPG (January 2012 to July 2021, n = 79).

Results: More patients in Cohort 1 were small for gestational age than in Cohort 2. No other patient demographics were different between cohorts. Cohort 2 had significantly lower ECMO utilization as compared to Cohort 1 (18% vs 50%, p<0.001). Cohort 2 had significantly higher survival to discharge compared to Cohort 1 (85% vs 57%, p<0.001). Survival for ECMO-treated patients in Cohort 2 was significantly higher than in Cohort 1 (71% vs 26%, p = 0.005). In Cohort 1, 70% of the non-survivors were repaired, of which 81% were repaired on ECMO. In Cohort 2, 8% of the non-survivors were repaired, none on ECMO. Only 3% in Cohort 2 were discharged with pulmonary hypertension medication.

Conclusions: A standardized CPG to manage patients with CDH decreased ECMO utilization and improved clinical outcomes including survival to discharge. Refinement of management strategies, implementation of new interventions, and meticulous care can improve outcomes in patients with CDH.

Keywords: Clinical practice guideline; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Survival.

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