Research: Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm

Front Pediatr

. 2022 Jul 18;10:945090.

 doi: 10.3389/fped.2022.945090. eCollection 2022.

Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm

Emily J J Horn-Oudshoorn 1Ronny Knol 1Suzan C M Cochius-den Otter 2Arjan B Te Pas 3Stuart B Hooper 4Calum T Roberts 4 5Neysan Rafat 6Thomas Schaible 6Willem P de Boode 7Robin van der Lee 7Anne Debeer 8Florian Kipfmueller 9Charles C Roehr 10 11 12Irwin K M Reiss 1Philip L J DeKoninck 4 13

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Background: Infants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the individual patient’s disease severity, but an individualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this individualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers.

Methods: An initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts.

Results: Eligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this individually.

Conclusions: Infants with mild CDH might benefit from an individualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this.

Keywords: birth; congenital diaphragmatic hernia; intubation; neonatal resuscitation; spontaneous breathing approach.

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