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Resuscitation of infants with congenital diaphragmatic hernia
Anthony O'Rourke-Potocki1, Kamal Ali2, Vadivelam Murthy1
1Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
Insights
Infants with congenital diaphragmatic hernia (CDH) who did not survive showed poorer respiratory responses during resuscitation, including lower expiratory tidal volume and end-tidal carbon dioxide levels. These findings highlight critical differences in resuscitation effectiveness for non-survivors.
Area of Science:
- Neonatal Medicine
- Pediatric Resuscitation
- Respiratory Physiology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring immediate respiratory support.
- Assessing the respiratory response during neonatal resuscitation is crucial for predicting outcomes.
Purpose of the Study:
- To investigate if the respiratory response to resuscitation in infants with CDH differs between survivors and non-survivors.
- To identify specific respiratory parameters that may predict mortality in CDH infants.
Main Methods:
- An observational study was conducted at a tertiary perinatal center.
- Thirty-eight infants with antenatally diagnosed CDH (gestational age ≥34 weeks) were included.
- Respiratory function monitor data (expiratory tidal volume, peak inflation pressure, end-tidal carbon dioxide) and oxygen saturation were recorded during resuscitation.
Main Results:
- Non-survivors had significantly lower expiratory tidal volume, end-tidal carbon dioxide, and compliance in the first minute of resuscitation.
- In the last minute of resuscitation, non-survivors exhibited higher peak inflation pressure, lower expiratory tidal volume, and lower compliance.
- Maximum oxygen saturation achieved was lower in non-survivors (93%) compared to survivors (100%).
Conclusions:
- Infants with CDH who did not survive demonstrated a less effective respiratory response to initial resuscitation efforts.
- Respiratory function monitoring during resuscitation can provide valuable insights into outcomes for CDH infants.
Objective:
To determine whether the respiratory response to resuscitation in infants with congenital diaphragmatic hernia (CDH) as measured by a respiratory function monitor differed between those who did and did not survive.
Design:
Observational study.
Setting:
Tertiary perinatal centre.
Patients:
Thirty-eight infants born at 34 weeks of gestation or greater and diagnosed antenatally with a CDH.
Interventions:
Expiratory tidal volume (VTe), peak inflation pressure (PIP) and end-tidal carbon dioxide level (ETCO2) were simultaneously recorded during resuscitation using a respiratory function monitor. Oxygen saturation was also monitored.
Main Outcome Measures:
Mortality related to the median VTe, PIP, compliance (VTe divided by PIP) and ETCO2 levels in the first and last minute of recorded resuscitation and the maximum oxygen saturation.
Results:
The median gestational age, birth weight and duration of resuscitation of the 11 infants who died did not differ significantly from those who survived. During the first minute of recorded resuscitation, the VTe (median 1.89 vs 2.68 mL/kg) (p=0.009)), the ETCO2 (median 11.7 vs 41.7 mm Hg) (p=0.023)) and the compliance (0.06 vs 0.08 mL/cm H2O/kg) (p=0.018)) were lower in the non-survivors. In the last minute, the PIP was higher (32.5 vs 30.3 cm H2O) (p=0.03)), the VTe (3.22 vs 4.66 mL/kg) (p=0.003)) and compliance (0.10 vs 0.15 mL/cm H2O/kg) (p=0.004)) were lower in the non-survivors. The maximum oxygen saturation achieved in the labour suite was lower in the non-survivors (93% vs 100%) (p=0.037).
Conclusions:
Infants with CDH who did not survive responded less well even to initial resuscitation.
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