Title

Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia.

Authors

Jake Riley, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Ryan M Antiel, Children's Hospital of Philadelphia, Philadelphia, PA
Natalie E Rintoul, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Anne M Ades, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Lindsay N Waqar, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Nan Lin, Children's Hospital of Philadelphia, Philadelphia, PA
Lisa M Herkert, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Jo Ann D'Agostino, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Casey Hoffman, Children's Hospital of Philadelphia, Philadelphia, PAFollow
William H Peranteau, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Alan W Flake, Children's Hospital of Philadelphia, Philadelphia, PAFollow
N Scott Adzick, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Holly L Hedrick, Children's Hospital of Philadelphia, Philadelphia, PAFollow

Publication Title

Journal of perinatology : official journal of the California Perinatal Association

Document Type

Article

PubMed ID

29887609

Abstract

Objective: To evaluate whether infants with congenital diaphragmatic hernia (CDH) can be safely resuscitated with a reduced starting fraction of inspired oxygen (FiO2) of 0.5.

Study design: A retrospective cohort study comparing 68 patients resuscitated with starting FiO2 0.5 to 45 historical controls resuscitated with starting FiO2 1.0.

Results: Reduced starting FiO2 had no adverse effect upon survival, duration of intubation, need for ECMO, duration of ECMO, or time to surgery. Furthermore, it produced no increase in complications, adverse neurological events, or neurodevelopmental delay. The need to subsequently increase FiO2 to 1.0 was associated with female sex, lower gestational age, liver up, lower lung volume-head circumference ratio, decreased survival, a higher incidence of ECMO, longer time to surgery, periventricular leukomalacia, and lower neurodevelopmental motor scores.

Conclusion: Starting FiO2 0.5 may be safe for the resuscitation of CDH infants. The need to increase FiO2 to 1.0 during resuscitation is associated with worse outcomes.

Keywords

Analysis of Variance, Case-Control Studies, Extracorporeal Membrane Oxygenation, Female, Hernias, Diaphragmatic, Congenital, Hospitals, Pediatric, Humans, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Male, Multivariate Analysis, Oxygen, Oxygen Consumption, Oxygen Inhalation Therapy, Patient Safety, Philadelphia, Pressure, Prognosis, Resuscitation, Retrospective Studies, Risk Assessment, Severity of Illness Index, Survival Rate, Treatment Outcome

DOI

10.1038/s41372-017-0031-5

Publication Date

7-1-2018

Citation

Riley, J., Antiel, R., Rintoul, N., Ades, A., Waqar, L., Lin, N., Herkert, L., D'Agostino, J., Hoffman, C., Peranteau, W., Flake, A., Adzick, N., & Hedrick, H. (2018). Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia.. Journal of perinatology : official journal of the California Perinatal Association, 38 (7), 834-843. https://doi.org/10.1038/s41372-017-0031-5