Research: Perioperative Improvement in Pulmonary Function in Infants with Congenital Diaphragmatic Hernia

J Pediatr

. 2022 Sep 28;S0022-3476(22)00859-9.

 doi: 10.1016/j.jpeds.2022.09.037. Online ahead of print.

Perioperative Improvement in Pulmonary Function in Infants with Congenital Diaphragmatic Hernia

Brian Scottoline 1Brian K Jordan 2Kseniya Parkhotyuk 2Diane Schilling 2Cindy T McEvoy 2

Affiliations expand


Objective: To compare serial changes in pulmonary function in contemporary infants with congenital diaphragmatic hernias (CDH) managed with a gentle ventilation approach.

Study design: Observational cohort, single-center study of infants ≥ 35 0/7 weeks gestation at delivery with CDH. FRC, passive respiratory compliance (Crs), and passive respiratory resistance (Rrs) were measured pre- and post-surgical repair and within two weeks of discharge. A one-way analysis of variance for repeated measures was used to evaluate the change in FRC, Crs, and Rrs over these repeated measures.

Results: Twenty-eight infants were included in the analysis with a mean gestational age of 38.3 weeks and birth weight of 3139 grams. We found a significant increase in FRC across the three timepoints (Mean in mL/kg (SD): 10.9 (3.6) to 18.5 (5.2) to 24.2 (4.4) ; p<0.0001). There was also a significant increase in Crs and decrease in Rrs. In contrast to a previous report, there were survivors in the current cohort with a preoperative FRC of < 9 mL/kg. The mean FRC measured at discharge was in the range considered within normal limits. Sixteen infants had prenatal measurements of lung-to-head ratio (LHR), but there was no relationship between the LHR and pre- or postoperative FRC measurements.

Conclusions: Infants with CDH demonstrate significant increases in FRC and improvements in respiratory mechanics measured pre- and postoperatively and at discharge. We speculate these improvements are due to the surgical resolution of the mechanical obstruction to lung recruitment, and that after achieving preoperative stability, repair should not be delayed given these demonstrable postoperative improvements.

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