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Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Emma Williams1, Anne Greenough1,2,3

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

Frontiers in Pediatrics
|January 10, 2022
PubMed

Insights

Optimizing respiratory support for infants with congenital diaphragmatic hernia (CDH) is crucial. Lung protective strategies are vital, while surfactant therapy and inhaled nitric oxide lack proven benefits in CDH patients.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Congenital diaphragmatic hernia (CDH) causes severe lung hypoplasia and pulmonary vasculature abnormalities.
  • This leads to ventilation-perfusion mismatch, impairing gas exchange in affected infants.
  • Effective respiratory support is critical for initial stabilization and post-surgical recovery.

Purpose of the Study:

  • To review and discuss optimal respiratory support strategies for infants with CDH.
  • To evaluate current evidence regarding specific therapies like surfactant and inhaled nitric oxide.
  • To explore potential benefits of novel ventilatory approaches.

Main Methods:

  • Literature review focusing on respiratory management in CDH.
  • Analysis of evidence for surfactant therapy and inhaled nitric oxide.
  • Discussion of emerging ventilatory modalities.

Main Results:

  • Lung protective ventilation is essential to prevent ventilator-induced lung injury and oxygen toxicity.
  • Current evidence does not support routine surfactant therapy or inhaled nitric oxide for CDH.
  • Pulmonary hypertension treatments are under investigation in clinical trials.

Conclusions:

  • Lung protective ventilation strategies are paramount in managing infants with CDH.
  • Further research is needed to establish the efficacy of novel ventilatory modalities like automated oxygen control, liquid ventilation, and heliox therapy.

Keywords:
high frequency oscillationinhaled nitric oxidemechanical ventilationpressure controlled ventilationsurfactantvolume controlled ventilation

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