Related Experiment Video

Updated: Aug 5, 2026

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
11:27

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

Published on: April 7, 2023

Team-based care with early recognition and treatment of cardiac dysfunction for infants with CDH

Patrick E Sloan1, Lila S Sanning2, Caren Liviskie3

  • 1Division of Newborn Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA. sloan.patrick@wustl.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|July 28, 2026
PubMed

Insights

A specialized congenital diaphragmatic hernia (CDH) team and early cardiac dysfunction treatment significantly improved infant survival rates and reduced the need for ECMO (extracorporeal membrane oxygenation).

Area of Science:

  • Neonatal surgery
  • Pediatric cardiology
  • Critical care medicine

Background:

  • Congenital diaphragmatic hernia (CDH) presents significant challenges in neonatal care.
  • Cardiac dysfunction is a major contributor to mortality in infants with CDH.
  • Optimizing management strategies is crucial for improving outcomes.

Purpose of the Study:

  • To evaluate the impact of a multidisciplinary core congenital diaphragmatic hernia (CDH) team.
  • To assess the effect of early recognition and treatment of cardiac dysfunction on infant outcomes.
  • To identify changes in management protocols and their correlation with survival and resource utilization.

Main Methods:

  • Retrospective chart review comparing two cohorts: historical (2015-2019) and post-guideline implementation (2020-2025).
  • Statistical analysis included Fisher's exact test, unpaired t-test, and Mann Whitney U-test.
  • Focus on outcomes such as survival, extracorporeal membrane oxygenation (ECMO) utilization, and vasoactive/inotropic agent use.

Main Results:

  • Survival improved significantly from 68.6% to 88.7% (p=0.016).
  • ECMO utilization decreased from 51.0% to 26.4% (p=0.015).
  • Infants with cardiac dysfunction showed improved survival (47.3% vs. 81.8%, p=0.014) and reduced ECMO use (68.4% vs. 36.3%, p=0.043).
  • Vasoactive medication strategies shifted, with decreased use of inhaled nitric oxide (iNO) and increased use of prostaglandin E1 (PGE1).

Conclusions:

  • Implementation of a core CDH team and a physiology-driven approach to cardiac dysfunction improved survival.
  • Standard neonatal echocardiography is effective for identifying and managing cardiac dysfunction in CDH.
  • The findings support a standardized, multidisciplinary approach for managing infants with congenital diaphragmatic hernia.
Abstract

More Related Videos

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography09:31

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography

Published on: January 27, 2023

Creation of Patient-Specific Silicone Cardiac Models with Applications in Pre-surgical Plans and Hands-on Training09:15

Creation of Patient-Specific Silicone Cardiac Models with Applications in Pre-surgical Plans and Hands-on Training

Published on: February 10, 2022

Related Concept Videos

Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
Cardiomyopathy IV: Restrictive Cardiomyopathy01:29

Cardiomyopathy IV: Restrictive Cardiomyopathy

Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
Cardiomyopathy VI: Nursing Management01:29

Cardiomyopathy VI: Nursing Management

Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
Cardiac Catheterization I: Pre-Procedure Overview01:28

Cardiac Catheterization I: Pre-Procedure Overview

Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...