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

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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 languageEnglish
Article number945090
Number of pages5
JournalFrontiers in Pediatrics
Publication statusPublished - 18 Jul 2022


  • birth
  • congenital diaphragmatic hernia
  • intubation
  • neonatal resuscitation
  • spontaneous breathing approach

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