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

OBJECTIVE

Identify how a core congenital diaphragmatic hernia (CDH) team coupled with early recognition and treatment of cardiac dysfunction changed outcomes for infants with CDH.

METHODS

A retrospective chart review compared a historical cohort from 2015-2019 (n = 51) with a post-guideline cohort from 2020-2025 (n = 53). Statistical analysis was performed with Fisher's exact, unpaired t-test, and Mann Whitney U-test.

RESULTS

Survival improved from 68.6% to 88.7% (p = 0.016) and ECMO utilization decreased, 51.0% to 26.4% (p = 0.015). Infants with cardiac dysfunction had increased survival (47.3% vs. 81.8%, p = 0.014) and less ECMO utilization (68.4% vs. 36.3%, p = 0.043). Vasoactive choices evolved with dopamine replaced by norepinephrine, low-dose epinephrine, or calcium gluconate. Inhaled nitric oxide (iNO) use in the first 48 h decreased significantly while prostaglandin E1 (PGE1) use increased.

DISCUSSION: We implemented a core CDH team focused on a generalizable, physiology-driven approach to identify and treat cardiac dysfunction using standard neonatal echocardiography to improve outcomes.