Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Abstract

Optimisation of respiratory support of infants with congenital diaphragmatic hernia (CDH) is critical. Infants with CDH often have severe lung hypoplasia and abnormal development of their pulmonary vasculature, leading to ventilation perfusion mismatch. It is vital that lung protective ventilation strategies are employed during both initial stabilisation and post-surgical repair to avoid ventilator induced lung damage and oxygen toxicity to prevent further impairment to an already diminished gas-exchanging environment. There is a lack of robust evidence for the routine use of surfactant therapy during initial resuscitation of infants with CDH and thus administration cannot be recommended outside clinical trials. Additionally, inhaled nitric oxide has been shown to have no benefit in reducing the mortality rates of infants with CDH. Other therapeutic agents which beneficially act on pulmonary hypertension are currently being assessed in infants with CDH in randomised multicentre trials. The role of novel ventilatory modalities such as closed loop automated oxygen control, liquid ventilation and heliox therapy may offer promise for infants with CDH, but the benefits need to be determined in appropriately designed clinical trials.

Mediastinal Shift Angle in Fetal MRI Is Associated With Prognosis, Severity, and Cardiac Underdevelopment in Left Congenital Diaphragmatic Hernia

“…Previous studies have shown that insufficient gas exchange within 24 h after birth is a risk factor for CDH neonates (22), suggesting that children with high MSA levels need close monitoring and prompt intervention early after birth to maintain improvement in oxygenation. We found that the MSA level was associated with the duration of mechanical ventilation, consistent with previous studies (23), illustrating that MSA values could reflect the severity of lung hypoplasia (24).…”

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

“…Although there was no reduction in BPD at 36 weeks, surfactant-treated infants had fewer episodes of rehospitalisation over the first year of life [209]. Routine surfactant therapy is not recommended in infants with congenital diaphragmatic hernia [210].…”

Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: The “NAVA‐diaph” pilot study

“…In each mode (NAVA and SIMV), the esophageal and transdiaph- [1], the maximal inspiratory EAdi value [2], the end of neural inspiration [3], and at the end of neural expiration [4], flow (beginning [5] and end [6]), and esophageal pressure (beginning [7] and end [8]). EAdi, the electrical activity of the diaphragm; NAVA, neurally adjusted ventilatory assist.…”

“…After surgical repair, it is also very important to avoid ventilator‐induced lung damage to prevent further impairment of the diaphragm and the lung, 4 and neurally adjusted ventilatory assist (NAVA; Maquet, Getinge) has been proposed to achieve this goal 5 . NAVA is a ventilatory mode that delivers synchronized assisted ventilation, proportional to the respiratory drive, using the electrical activity of the patient's diaphragm (EAdi) 6 .…”