Article Text

other Versions

PDF
Resuscitation of infants with congenital diaphragmatic hernia
  1. Anthony O'Rourke-Potocki1,
  2. Kamal Ali2,
  3. Vadivelam Murthy1,
  4. Anthony Milner1,
  5. Anne Greenough1,3
  1. 1Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
  2. 2Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
  3. 3National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas’ NHS Foundation Trust and King's College London, London, UK
  1. Correspondence to Professor Anne Greenough, Neonatal Intensive Care Unit, 4th Floor Golden Jubilee Wing, King's College Hospital, Denmark Hill, London SE5 9RS, UK; anne.greenough{at}kcl.ac.uk

Abstract

Objective To determine whether the respiratory response to resuscitation in infants with congenital diaphragmatic hernia (CDH) as measured by a respiratory function monitor differed between those who did and did not survive.

Design Observational study.

Setting Tertiary perinatal centre.

Patients Thirty-eight infants born at 34 weeks of gestation or greater and diagnosed antenatally with a CDH.

Interventions Expiratory tidal volume (VTe), peak inflation pressure (PIP) and end-tidal carbon dioxide level (ETCO2) were simultaneously recorded during resuscitation using a respiratory function monitor. Oxygen saturation was also monitored.

Main outcome measures Mortality related to the median VTe, PIP, compliance (VTe divided by PIP) and ETCO2 levels in the first and last minute of recorded resuscitation and the maximum oxygen saturation.

Results The median gestational age, birth weight and duration of resuscitation of the 11 infants who died did not differ significantly from those who survived. During the first minute of recorded resuscitation, the VTe (median 1.89 vs 2.68 mL/kg) (p=0.009)), the ETCO2 (median 11.7 vs 41.7 mm Hg) (p=0.023)) and the compliance (0.06 vs 0.08 mL/cm H2O/kg) (p=0.018)) were lower in the non-survivors. In the last minute, the PIP was higher (32.5 vs 30.3 cm H2O) (p=0.03)), the VTe (3.22 vs 4.66 mL/kg) (p=0.003)) and compliance (0.10 vs 0.15 mL/cm H2O/kg) (p=0.004)) were lower in the non-survivors. The maximum oxygen saturation achieved in the labour suite was lower in the non-survivors (93% vs 100%) (p=0.037).

Conclusions Infants with CDH who did not survive responded less well even to initial resuscitation.

  • Congenital diaphragmatic hernia
  • Resuscitation
  • compliance

Statistics from Altmetric.com

Footnotes

  • Contributors AG, AM and KA designed the study. VM collected the data. AO'R-P and KA analysed the data. All authors were involved in producing the manuscript and approved the final version.

  • Funding The research was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas' NHS Foundation Trust and King’s College London.

  • Competing interests None declared.

  • Ethics approval Outer London Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data can be open for sharing if required.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.