The following is a summary of “Perioperative Improvement in Pulmonary Function in Infants with Congenital Diaphragmatic Hernia,” published in the FEBRUARY 2023 issue of Pediatrics by Scottoline et al.
For a study, researchers sought to assess serial changes in pulmonary function in contemporary infants with congenital diaphragmatic hernia (CDH) managed with a gentle ventilation approach.
This was an observational cohort, single-center study of infants with CDH delivered ≥350/7 weeks of gestation. Functional residual capacity (FRC), passive respiratory compliance, and passive respiratory resistance were measured during presurgical and postsurgical repair and within 2 weeks of discharge. A total of 28 infants with a mean gestational age of 38.3 weeks and birth weight of 3,139 g were included in the analysis. A 1-way analysis of variance for repeated measures was used to evaluate the change in FRC, passive respiratory compliance, and passive respiratory resistance over these repeated measures.
The study found a significant increase in FRC across the three-time points (mean in mL/kg [SD]: 10.9 [3.6] to 18.5 [5.2] to 24.2 [4.4]; P < .0001). There was also a significant increase in passive respiratory compliance and a decrease in passive respiratory resistance. Despite previous reports, survivors in the current cohort had a preoperative FRC of <9 mL/kg. The mean FRC measured at discharge was within the range considered within normal limits. No relationship existed between the lung-to-head ratio and preoperative or postoperative FRC measurements.
Infants with CDH who underwent a gentle ventilation approach demonstrated significant improvements in FRC and respiratory mechanics measured preoperatively, postoperatively, and at discharge. The improvements were likely due to the surgical resolution of the mechanical obstruction to lung recruitment. Therefore, CDH repair should not be delayed after achieving preoperative stability, as these demonstrable postoperative improvements are crucial.