Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm

Emily J.J. Horn-Oudshoorn; Ronny Knol; Suzan C.M. Cochius-den Otter; Arjan B. te Pas; Stuart B. Hooper; Calum T. Roberts; Neysan Rafat; Thomas Schaible; Willem P. de Boode; Robin van der Lee; Anne Debeer; Florian Kipfmueller; Charles C. Roehr; Irwin K.M. Reiss; Philip L.J. DeKoninck

doi:10.3389/fped.2022.945090

Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm

Emily J.J. Horn-Oudshoorn, Ronny Knol, Suzan C.M. Cochius-den Otter, Arjan B. te Pas, Stuart B. Hooper, Calum T. Roberts, Neysan Rafat, Thomas Schaible, Willem P. de Boode, Robin van der Lee, Anne Debeer, Florian Kipfmueller, Charles C. Roehr, Irwin K.M. Reiss, Philip L.J. DeKoninck^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Infants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the individual patient's disease severity, but an individualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this individualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers. Methods: An initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts. Results: Eligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this individually. Conclusions: Infants with mild CDH might benefit from an individualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this.

Original language	English
Article number	945090
Pages (from-to)	1-5
Number of pages	5
Journal	Frontiers in Pediatrics
Volume	10
DOIs	https://doi.org/10.3389/fped.2022.945090
Publication status	Published - 18 Jul 2022

Bibliographical note

Funding Information:
The authors thank Dr. R. C. J. de Jonge, E. E. Langenberg, Dr. N. van Paassen, Profs. Drs. D. Tibboel, and R. M. H. Wijnen from the Erasmus MC for their contribution to this algorithm. This proposal has been endorsed by the European Scientific Collaboration on Neonatal Resuscitation Research (ESCNR), a section of the European Society for Pediatric Research (ESPR), and the CDH EURO Consortium.

Funding Information:
EH-O and PD are supported by a grant from Sophia Children's Hospital Foundation (SSWO, grant S19-12).

Publisher Copyright:
Copyright © 2022 Horn-Oudshoorn, Knol, Cochius-den Otter, te Pas, Hooper, Roberts, Rafat, Schaible, de Boode, van der Lee, Debeer, Kipfmueller, Roehr, Reiss and DeKoninck.

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Horn-Oudshoorn, E. J. J., Knol, R., Cochius-den Otter, S. C. M., te Pas, A. B., Hooper, S. B., Roberts, C. T., Rafat, N., Schaible, T., de Boode, W. P., van der Lee, R., Debeer, A., Kipfmueller, F., Roehr, C. C., Reiss, I. K. M., & DeKoninck, P. L. J. (2022). Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm. Frontiers in Pediatrics, 10, 1-5. Article 945090. https://doi.org/10.3389/fped.2022.945090

@article{aed8f16da7cf41d492d259db692d8dd1,

title = "Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm",

abstract = "Background: Infants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the individual patient's disease severity, but an individualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this individualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers. Methods: An initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts. Results: Eligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this individually. Conclusions: Infants with mild CDH might benefit from an individualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this.",

author = "Horn-Oudshoorn, {Emily J.J.} and Ronny Knol and {Cochius-den Otter}, {Suzan C.M.} and {te Pas}, {Arjan B.} and Hooper, {Stuart B.} and Roberts, {Calum T.} and Neysan Rafat and Thomas Schaible and {de Boode}, {Willem P.} and {van der Lee}, Robin and Anne Debeer and Florian Kipfmueller and Roehr, {Charles C.} and Reiss, {Irwin K.M.} and DeKoninck, {Philip L.J.}",

note = "Funding Information: The authors thank Dr. R. C. J. de Jonge, E. E. Langenberg, Dr. N. van Paassen, Profs. Drs. D. Tibboel, and R. M. H. Wijnen from the Erasmus MC for their contribution to this algorithm. This proposal has been endorsed by the European Scientific Collaboration on Neonatal Resuscitation Research (ESCNR), a section of the European Society for Pediatric Research (ESPR), and the CDH EURO Consortium. Funding Information: EH-O and PD are supported by a grant from Sophia Children's Hospital Foundation (SSWO, grant S19-12). Publisher Copyright: Copyright {\textcopyright} 2022 Horn-Oudshoorn, Knol, Cochius-den Otter, te Pas, Hooper, Roberts, Rafat, Schaible, de Boode, van der Lee, Debeer, Kipfmueller, Roehr, Reiss and DeKoninck.",

year = "2022",

month = jul,

day = "18",

doi = "10.3389/fped.2022.945090",

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Horn-Oudshoorn, EJJ , Knol, R , Cochius-den Otter, SCM, te Pas, AB, Hooper, SB, Roberts, CT, Rafat, N, Schaible, T, de Boode, WP, van der Lee, R, Debeer, A, Kipfmueller, F, Roehr, CC, Reiss, IKM & DeKoninck, PLJ 2022, 'Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm', Frontiers in Pediatrics, vol. 10, 945090, pp. 1-5. https://doi.org/10.3389/fped.2022.945090

TY - JOUR

T1 - Spontaneous breathing approach in mild congenital diaphragmatic hernia

T2 - A resuscitation algorithm

AU - Horn-Oudshoorn, Emily J.J.

AU - Knol, Ronny

AU - Cochius-den Otter, Suzan C.M.

AU - te Pas, Arjan B.

AU - Hooper, Stuart B.

AU - Roberts, Calum T.

AU - Rafat, Neysan

AU - Schaible, Thomas

AU - de Boode, Willem P.

AU - van der Lee, Robin

AU - Debeer, Anne

AU - Kipfmueller, Florian

AU - Roehr, Charles C.

AU - Reiss, Irwin K.M.

AU - DeKoninck, Philip L.J.

N1 - Funding Information: The authors thank Dr. R. C. J. de Jonge, E. E. Langenberg, Dr. N. van Paassen, Profs. Drs. D. Tibboel, and R. M. H. Wijnen from the Erasmus MC for their contribution to this algorithm. This proposal has been endorsed by the European Scientific Collaboration on Neonatal Resuscitation Research (ESCNR), a section of the European Society for Pediatric Research (ESPR), and the CDH EURO Consortium. Funding Information: EH-O and PD are supported by a grant from Sophia Children's Hospital Foundation (SSWO, grant S19-12). Publisher Copyright: Copyright © 2022 Horn-Oudshoorn, Knol, Cochius-den Otter, te Pas, Hooper, Roberts, Rafat, Schaible, de Boode, van der Lee, Debeer, Kipfmueller, Roehr, Reiss and DeKoninck.

PY - 2022/7/18

Y1 - 2022/7/18

N2 - Background: Infants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the individual patient's disease severity, but an individualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this individualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers. Methods: An initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts. Results: Eligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this individually. Conclusions: Infants with mild CDH might benefit from an individualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this.

AB - Background: Infants with a congenital diaphragmatic hernia (CDH) and expected mild pulmonary hypoplasia have an estimated survival rate of 90%. Current guidelines for delivery room management do not consider the individual patient's disease severity, but an individualized approach with spontaneous breathing instead of routine mechanical ventilation could be beneficial for the mildest cases. We developed a resuscitation algorithm for this individualized approach serving two purposes: improving the success rate by structuring the approach and providing a guideline for other centers. Methods: An initial algorithm was discussed with all local stakeholders. Afterwards, the resulting algorithm was refined using input from international experts. Results: Eligible CDH infants: left-sided defect, observed to expected lung-to-head ratio ≥50%, gestational age at birth ≥37.0 weeks, and no major associated structural or genetic abnormalities. To facilitate fetal-to-neonatal transition, we propose to start stabilization with non-invasive respiratory support and to adjust this individually. Conclusions: Infants with mild CDH might benefit from an individualized approach for neonatal resuscitation. Herein, we present an algorithm that could serve as guidance for centers implementing this.

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U2 - 10.3389/fped.2022.945090

DO - 10.3389/fped.2022.945090

M3 - Article

C2 - 35923783

AN - SCOPUS:85136908649

SN - 2296-2360

VL - 10

SP - 1

EP - 5

JO - Frontiers in Pediatrics

JF - Frontiers in Pediatrics

M1 - 945090

ER -

Spontaneous breathing approach in mild congenital diaphragmatic hernia: A resuscitation algorithm

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