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Impact of a standardized management guideline for infants with CDH: A single-center experience

Katrin Lichtsinn1, Paul K Waltz2, Abeer Azzuqa1

  • 1University of Pittsburgh Medical Center, Division of Newborn Medicine. 4401 Penn Ave, Pittsburgh, PA, USA 15224.

Journal of Pediatric Surgery
|August 14, 2022
PubMed

Insights

Implementing a clinical practice guideline for congenital diaphragmatic hernia (CDH) significantly reduced extracorporeal membrane oxygenation (ECMO) use and improved survival rates in infants. This standardized approach enhances outcomes for CDH patients.

Area of Science:

  • Neonatal Surgery
  • Pediatric Critical Care
  • Medical Quality Improvement

Background:

  • Infants with congenital diaphragmatic hernia (CDH) face high mortality risks, even with advanced life support like extracorporeal membrane oxygenation (ECMO).
  • A standardized clinical practice guideline (CPG) was implemented in January 2012 to manage infants with CDH.
  • The study hypothesized that CPG implementation would lead to better clinical outcomes, reduced ECMO utilization, and increased survival to discharge.

Purpose of the Study:

  • To evaluate the impact of a standardized clinical practice guideline (CPG) on clinical outcomes in infants with congenital diaphragmatic hernia (CDH).
  • To assess changes in extracorporeal membrane oxygenation (ECMO) utilization and survival to discharge following CPG implementation.
  • To compare outcomes between infants managed before and after the introduction of the CDH CPG.

Main Methods:

  • A retrospective pre-post study design was employed, analyzing 133 infants with CDH admitted between January 2007 and July 2021.
  • Patients were divided into two cohorts: pre-CPG (January 2007-December 2011, n=54) and post-CPG (January 2012-July 2021, n=79).
  • Demographic data, ECMO utilization, surgical repair details, and survival to discharge were compared between the two cohorts.

Main Results:

  • The post-CPG cohort (Cohort 2) showed significantly lower ECMO utilization (18%) compared to the pre-CPG cohort (Cohort 1, 50%).
  • Survival to discharge was significantly higher in Cohort 2 (85%) than in Cohort 1 (57%).
  • Survival for ECMO-treated infants improved dramatically in Cohort 2 (71%) versus Cohort 1 (26%), with a notable decrease in repairs performed on ECMO in the post-CPG group.

Conclusions:

  • A standardized CPG for managing congenital diaphragmatic hernia (CDH) effectively decreases ECMO utilization and improves survival to discharge.
  • Refinement of management strategies, incorporation of new interventions, and meticulous care are crucial for enhancing outcomes in CDH patients.
  • The study highlights the significant benefits of standardized care protocols in improving outcomes for critically ill infants with CDH.
Abstract

Keywords:
Clinical practice guidelineCongenital diaphragmatic herniaExtracorporeal membrane oxygenationSurvival

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