Florian Kipfmueller, Judith Leyens, Flaminia Pugnaloni, Bartolomeo Bo, Tamara Grass, Lotte Lemloh, Lukas Schroeder, Patrizia Nitsch‐Felsecker, Christoph Berg, Andreas Heydweiller, Brigitte Strizek, Andreas Mueller
Children’s Hospital and University Hospital Bonn and University of Bonn. “Bambino Gesù” Children’s Hospital.
Germany and Italy
Pediatric Pulmonology
Pediatr Pulmonol 2023;
DOI: 10.1002/ppul.26791
Abstract
Aims: Current treatment guidelines recommend immediate postnatal intubation in all neonates with congenital diaphragmatic hernia (CDH). This study aimed to investigate the feasibility and outcomes of a spontaneous breathing approach (SBA) versus immediate intubation in neonates with prenatally diagnosed very mild CDH.
Methods: A retrospective study was conducted comparing neonates with very mild CDH (left-sided, liver-down, observed-to-expected lung-to-head ratio ≥45%) undergoing SBA and matched controls receiving standard treatment. Data on early echocardiographic findings, respiratory support, length of hospital stay, and clinical outcomes were analyzed.
Results: Of 151 CDH neonates, eight underwent SBA, while 31 received standard treatment. SBA was successful in six of eight patients. SBA patients had shorter length of stay (14 vs. 30 days, p = .005), mechanical ventilation (3.5 vs. 8.7 days, p = .011), and oxygen supplementation (3.2 vs. 9.3 days, p = .013) compared to matched controls. Echocardiographic evidence of pulmonary hypertension and cardiac dysfunction were significantly lower in SBA neonates after admission but similar before surgical repair. The SBA group tolerated enteral feeding earlier (day of life 7 vs. 16, p = .019).
Conclusions: SBA appears feasible and beneficial for prenatally diagnosed very mild CDH. It was associated with a shortened hospital stay supportive therapies. However, larger trials are needed to confirm these findings and determine optimal respiratory support.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes