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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Preoperative cardiorespiratory trends in infants with congenital diaphragmatic hernia

S T Moffitt1, K F Schulze, R Sahni

  • 1Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

Journal of Pediatric Surgery
|April 1, 1995
PubMed

Insights

Infants with congenital diaphragmatic hernia (CDH) show similar early cardiopulmonary trends to healthy newborns. Continuous monitoring can identify deviations indicating potential treatment failure in CDH patients.

Area of Science:

  • Neonatology
  • Pediatric Cardiology
  • Pulmonology

Background:

  • Congenital diaphragmatic hernia (CDH) presents significant cardiovascular and pulmonary challenges in newborns.
  • Understanding early physiological adaptations is crucial for managing infants with CDH.

Purpose of the Study:

  • To continuously monitor and analyze cardiovascular and pulmonary adaptations in infants with CDH from birth until surgery.
  • To establish baseline physiological trends in ventilated CDH infants during the early postnatal period.

Main Methods:

  • Continuous on-line monitoring of cardiovascular (HR, BP, oxygen saturation) and ventilatory parameters using a computerized plethysmograph-incubator (Vital-trends, VT1000).
  • Measurements were taken in nine ventilated infants with CDH, starting at birth and continuing until surgical intervention.
  • Data analysis involved calculating minute and hourly means, averaging across infants, and regressing against postnatal age for the first 50 hours of life.

Main Results:

  • Significant increases observed in blood pressure (BP), BP variability (BP-SD), heart rate variability (HR-SD), and pH with advancing postnatal age.
  • Significant decreases noted in PaCO2, fraction of inspired oxygen (FIO2), alveolar-arterial oxygen gradient, and oxygenation index.
  • Cardiopulmonary trends in CDH infants were qualitatively similar to those of normal newborns during the first 48 hours.

Conclusions:

  • Early cardiopulmonary adaptations in infants with CDH follow patterns similar to healthy neonates.
  • Deviations from these established trends may signal suboptimal response to therapy.
  • Identifying such deviations can prompt consideration of alternative treatment strategies for CDH infants.

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