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Anatomical deadspace during resuscitation of infants with congenital diaphragmatic hernia

Emma E Williams1, Theodore Dassios2, Vadivelam Murthy3

  • 1Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Science and Medicine, King's College London, SE5 9RS, United Kingdom.

Early Human Development
|August 11, 2020
PubMed

Insights

Congenital diaphragmatic hernia (CDH) survivors had greater anatomical deadspace, indicating less severe lung hypoplasia. Fetal tracheal occlusion (FETO) also increased anatomical deadspace in these infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Respiratory Physiology

Background:

  • Congenital diaphragmatic hernia (CDH) is associated with significant mortality and morbidity due to pulmonary hypoplasia.
  • Pulmonary hypoplasia in CDH infants leads to respiratory complications and increased mortality rates.

Purpose of the Study:

  • To investigate if surviving CDH infants exhibit greater anatomical deadspace, suggesting less severe pulmonary hypoplasia.
  • To determine if fetal tracheal occlusion (FETO) influences anatomical deadspace in CDH infants.

Main Methods:

  • Volumetric capnography was used to measure anatomical deadspace in infants with CDH.
  • Measurements were taken during resuscitation immediately after delivery, with infants intubated and ventilated.
  • The study included 30 infants diagnosed with CDH antenatally, with 11 having undergone FETO.

Main Results:

  • Infants who survived to discharge had significantly higher anatomical deadspace (2.9 mls/kg) compared to those who died (2.2 mls/kg).
  • Infants who underwent FETO demonstrated increased anatomical deadspace (3.0 mls/kg) compared to those without FETO (2.8 mls/kg).
  • Anatomical deadspace was a strong predictor of survival to discharge, with an AUC of 0.90.

Conclusions:

  • Larger anatomical deadspace in surviving CDH infants suggests less severe pulmonary hypoplasia.
  • FETO may lead to increased anatomical deadspace, potentially due to distension of conducting airways.
Abstract

Keywords:
Anatomical deadspaceCongenital diaphragmatic herniaFeto-tracheal occlusionResuscitation

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