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Original research
Respiratory function after birth in infants with congenital diaphragmatic hernia
  1. K Taylor Wild1,
  2. Leny Mathew2,
  3. Holly L Hedrick3,4,
  4. Natalie E Rintoul1,4,
  5. Anne Ades1,4,
  6. Leane Soorikian1,
  7. Kelle Matthews1,
  8. Michael A Posencheg1,4,
  9. Erin Kesler3,
  10. K Taylor Van Hoose3,
  11. Howard B Panitch4,5,
  12. John Flibotte1,4,
  13. Elizabeth E Foglia1,4
  1. 1 Department of Pediatrics, The Children's Hospital of Philadelphia Division of Neonatology, Philadelphia, Pennsylvania, USA
  2. 2 Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3 Department of Pediatric General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  4. 4 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5 Division of Pulmonary and Sleep Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr K Taylor Wild, Department of Pediatrics, The Children's Hospital of Philadelphia Division of Neonatology, Philadelphia, PA 19104, USA; wildk{at}chop.edu

Abstract

Objective To characterise the transitional pulmonary physiology of infants with congenital diaphragmatic hernia (CDH) using measures of expiratory tidal volume (TV) and end-tidal carbon dioxide (ETCO2).

Design Prospective single-centre observational study.

Setting Quaternary neonatal intensive care unit.

Patients Infants with an antenatal diagnosis of CDH born at the Children’s Hospital of Philadelphia.

Interventions TV and ETCO2 were simultaneously recorded using a respiratory function monitor (RFM) during invasive positive pressure ventilation immediately after birth.

Main outcome measures TV per birth weight and ETCO2 values were summarised for each minute after birth. Subgroups of interest were defined by liver position (thoracic vs abdominal) and extracorporeal membrane oxygenation (ECMO) treatment.

Results RFM data were available for 50 infants from intubation until a median (IQR) of 9 (7–14) min after birth. TV and ETCO2 values increased for the first 10 min after birth, but intersubject values were heterogeneous. TVs were overall lower and ETCO2 values higher in infants with an intrathoracic liver and infants who were ultimately treated with ECMO. On hospital discharge, survival was 88% (n=43) and 34% (n=17) of infants were treated with ECMO.

Conclusion Respiratory function immediately after birth is heterogeneous for infants with CDH. Lung aeration, as evidenced by expired TV and ETCO2, appears to be ongoing throughout the first 10 min after birth during invasive positive pressure ventilation. Close attention to expired TV and ETCO2 levels by 10 min after birth may provide an opportunity to optimise and individualise ventilatory support for this high-risk population.

  • resuscitation
  • neonatology

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/archdischild-2022-324415

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Twitter @anmoad

    • Contributors KTW and EEF conceptualized and designed the study, collected and analysed the data, drafted the initial manuscript, and reviewed and revised the manuscript. LS, KM, EK and KTVH collected data and reviewed and revised the manuscript. LM, HLH, NER, AA, MAP, HBP and JF assisted in designing the study, analysing the data, and reviewed and revised the manuscript. EEF provided oversight and serves as the guarantor for the article. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding Children’s Hospital of Philadelphia Delivery Room of the Future Frontier Program, Children’s Hospital of Philadelphia Pulmonary Hypoplasia Program Frontier Program, National Institute of Child Health and Human Development (K23HD084727).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.