Carly Byrd, Julie Nogee, Maureen M Gilmore, Ahmet Baschat, Amaris Keiser, Jennifer Organ, Shaun Kunisaki, Suneetha Desiraju
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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.
期刊介绍：
The Journal of Perinatology provides members of the perinatal/neonatal healthcare team with original information pertinent to improving maternal/fetal and neonatal care. We publish peer-reviewed clinical research articles, state-of-the art reviews, comments, quality improvement reports, and letters to the editor. Articles published in the Journal of Perinatology embrace the full scope of the specialty, including clinical, professional, political, administrative and educational aspects. The Journal also explores legal and ethical issues, neonatal technology and product development.
The Journal’s audience includes all those that participate in perinatal/neonatal care, including, but not limited to neonatologists, perinatologists, perinatal epidemiologists, pediatricians and pediatric subspecialists, surgeons, neonatal and perinatal nurses, respiratory therapists, pharmacists, social workers, dieticians, speech and hearing experts, other allied health professionals, as well as subspecialists who participate in patient care including radiologists, laboratory medicine and pathologists.
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