Interhospital Transport Characteristics for Neonates With Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) occurs when a diaphragmatic defect develops in utero, allowing herniation of the abdominal contents into the chest cavity. As a result, many neonates with CDH are critically ill after birth owing to varying degrees of pulmonary hypoplasia, respiratory failure, pulmonary hypertension, and cardiac dysfunction. Neonates with CDH require surgical repair of the diaphragmatic defect, and those who are not born at a center with the ability to perform pediatric surgery must be transferred to one shortly after birth. Our objective was to describe transport characteristics and vital sign variability for neonates with CDH transferred after delivery.

This was a retrospective observational analysis of 51 neonates with prenatally diagnosed CDH born at a single delivery hospital between March 2020 and March 2024 and transported to a single tertiary referral neonatal intensive care unit. Descriptive statistics were used to compare groups by CDH severity.

Neonates with severe CDH were transported more rapidly than those with mild or moderate CDH. During transport, more neonates with severe disease received inhaled nitric oxide, but other transport interventions were not significantly different between the groups. All neonates experienced at least 1 abnormal vital sign. A higher proportion of neonates with severe CDH had low oxygen saturation values compared with those with milder disease.

Vital sign abnormalities were universally common during transport, highlighting the physiologic instability of neonates with CDH. Understanding these transport variables will aid provider teams in decision making for these critically ill neonates.