Clinical outcomes after implementation of a physiologic pre-operative management strategy in neonates with congenital diaphragmatic hernia.

OBJECTIVE

To evaluate neonatal outcomes in congenital diaphragmatic hernia (CDH) after implementation of new preoperative management guidelines based on physiologic fetal-to-neonatal transition.

STUDY

DESIGN

A retrospective single-center study of neonates with CDH was performed. Data were collected from 48 infants treated prior to new guideline implementation (Epoch 1) and 13 patients treated after implementation (Epoch 2). We hypothesized that rates of extracorporeal life support (ECLS) and inhaled nitric oxide (iNO) utilization would decrease after guideline implementation.

RESULTS

Neonates from Epoch 2 had a lower need for ECLS (p = 0.009) and iNO (p < 0.001) compared to Epoch 1. Compared to Epoch 1, neonates in Epoch 2 had decreased invasive mechanical ventilation duration (p = 0.001).

CONCLUSION

Implementation of physiologically driven management guidelines led to reduced rates of ECLS cannulation, ventilator days, and iNO utilization. This study demonstrates the impact of pre-operative physiologic management in improving short-term outcomes of CDH patients.