Research: Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia

Pediatr Pulmonol

. 2023 Nov 29.

 doi: 10.1002/ppul.26791. Online ahead of print.

Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia

Florian Kipfmueller 1Judith Leyens 1Flaminia Pugnaloni 1 2Bartolomeo Bo 1Tamara Grass 1Lotte Lemloh 1Lukas Schroeder 1Patrizia Nitsch-Felsecker 1Christoph Berg 3Andreas Heydweiller 4Brigitte Strizek 3Andreas Mueller 1

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Aims: Current treatment guidelines recommend immediate postnatal intubation in all neonates with congenital diaphragmatic hernia (CDH). This study aimed to investigate the feasibility and outcomes of a spontaneous breathing approach (SBA) versus immediate intubation in neonates with prenatally diagnosed very mild CDH.

Methods: A retrospective study was conducted comparing neonates with very mild CDH (left-sided, liver-down, observed-to-expected lung-to-head ratio ≥45%) undergoing SBA and matched controls receiving standard treatment. Data on early echocardiographic findings, respiratory support, length of hospital stay, and clinical outcomes were analyzed.

Results: Of 151 CDH neonates, eight underwent SBA, while 31 received standard treatment. SBA was successful in six of eight patients. SBA patients had shorter length of stay (14 vs. 30 days, p = .005), mechanical ventilation (3.5 vs. 8.7 days, p = .011), and oxygen supplementation (3.2 vs. 9.3 days, p = .013) compared to matched controls. Echocardiographic evidence of pulmonary hypertension and cardiac dysfunction were significantly lower in SBA neonates after admission but similar before surgical repair. The SBA group tolerated enteral feeding earlier (day of life 7 vs. 16, p = .019).

Conclusions: SBA appears feasible and beneficial for prenatally diagnosed very mild CDH. It was associated with a shortened hospital stay supportive therapies. However, larger trials are needed to confirm these findings and determine optimal respiratory support.

Keywords: cardiac dysfunction; congenital diaphragmatic hernia; mechanical ventilation; pulmonary hypertension; spontaneous breathing.

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