Analysis of neuromuscular blockade use and prognosis in resuscitation of isolated congenital diaphragmatic hernia: data from Japanese CDH Study Group.

PURPOSE: Neuromuscular blocking agents (NMBAs) may reduce lung compliance and affect long-term outcomes in congenital diaphragmatic hernia (CDH). This study investigated the association between NMBA use during CDH resuscitation and outcomes, including neurodevelopmental impairment (NDI) and sensorineural hearing loss (SNHL).

METHODS

We retrospectively analyzed 438 isolated CDH cases from the Japanese CDH Study Group registry (2006–2021), comparing those who received NMBAs at 5 min post-birth with those who did not. Outcomes included mortality, hospital stay, weaning from ventilation, NDI, and SNHL at discharge and at 1.5, 3, and 6 years. Cox proportional hazards models assessed prognosis in prenatally classified mild and moderate-to-extreme groups.

RESULTS

NMBA recipients (n = 138) had more severe prenatal findings, higher 5-min intubation rates, greater early oxygenation index, and longer hospital stays (55 vs. 46 days, p < 0.01). Mortality was higher but not significant (19% vs. 13%, p = 0.09). Adjusted hazard ratios for NDI and SNHL showed no significant associations overall or by severity group.

CONCLUSIONS

NMBA use in CDH resuscitation was not significantly associated with mortality, NDI, or SNHL. Further studies evaluating NMBA duration and cumulative exposure are needed to clarify its potential impact on outcomes.