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Review
Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts
  1. Emily J J Horn-Oudshoorn1,
  2. Ronny Knol1,
  3. Arjan B Te Pas2,
  4. Stuart B Hooper3,
  5. Suzan C M Cochius-den Otter4,
  6. René M H Wijnen4,
  7. Thomas Schaible5,
  8. Irwin K M Reiss1,
  9. Philip L J DeKoninck3,6
  1. 1 Division of Neonatology, Department of Paediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  2. 2 Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 The Ritchie Centre, Hudson Institute for Medical Research, Monash University, Melbourne, Victoria, Australia
  4. 4 Intensive Care and Department of Paediatric Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  5. 5 Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
  6. 6 Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Philip L J DeKoninck, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands; p.dekoninck{at}erasmusmc.nl

Abstract

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.

  • congenital abnorm
  • resuscitation
  • neonatology
  • physiology
  • fetal medicine
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/archdischild-2019-318606

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    • Contributors EJJHO wrote the initial draft of the manuscript. All authors participated in critical revision of the manuscript. EJJHO and PLJD processed the remarks and accounted for the final version of the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding EJJHO and PLJD are supported by a grant from Sophia Children’s Hospital Foundation (SSWO, grant S19-12).

    • Competing interests ABTP and SBH are members of the advisory committee of Concord Neonatal; however, the authors declare that Concord Neonatal had no influence on the contents of this paper.

    • Patient consent for publication Not required.

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

    • Data availability statement Data sharing is not applicable as no data sets were generated and/or analysed for this study.

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    © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.