An evidence-based treatment algorithm for congenital diaphragmatic hernia

Area of Science:

• Neonatal Surgery
• Pediatric Cardiology
• Critical Care Medicine

Background:

• Congenital diaphragmatic hernia (CDH) impacts over 1100 US newborns annually with variable severity.
• Current CDH management lacks standardization, hindering consistent decision-making and treatment goal clarity.
• Standardized care protocols are known to improve patient outcomes in complex conditions.

Purpose of the Study:

• To develop and implement a standardized treatment algorithm for congenital diaphragmatic hernia (CDH).
• To address variability in CDH clinical presentation and management.
• To improve outcomes for newborns diagnosed with CDH.

Main Methods:

• Comprehensive literature review focusing on cardiac dysfunction, ECMO indications, and repair timing.
• Collaborative development of a treatment algorithm with multidisciplinary experts.
• Integration of institutional experience with current CDH literature.

Main Results:

• Left ventricular (LV) hypoplasia and dysfunction significantly contribute to CDH severity and poor outcomes.
• Severe hypoxic respiratory failure refractory to medical therapy is a primary indication for neonatal extracorporeal membrane oxygenation (ECMO).
• Optimal surgical repair timing relative to ECMO remains an evolving aspect of CDH management.

Conclusions:

• Recommend prompt echocardiogram for cardiac evaluation post-birth in CDH cases.
• Advocate for early ECMO repair in high-risk CDH infants and delayed post-ECMO repair in low-risk infants.
• The developed algorithm represents a step towards standardizing CDH care to enhance patient outcomes.