Stabilisation of cardiopulmonary function in newborns with congenital diaphragmatic hernia using lung function parameters and hemodynamic management.
OBJECTIVE
Evaluation of lung function parameters and additional use of prostaglandin E1 (PGE1) for the stabilisation of cardiopulmonary function in patients with congenital diaphragmatic hernia (CDH) and pulmonary hypertension (PHT).


METHODS
Observational study.


METHODS
Between 2007 and 2009 8 patients with CDH have been treated in our pediatric intensive care unit (gestational age 34 + 0 - 40 + 4 weeks, birth weight 2 160-3 840 g). All patients required respiratory support. Gentle mechanical ventilation adapted to the degree of pulmonary hypoplasia based on serially measurements of lung function parameters to find appropriate ventilator settings has been performed.


RESULTS
Functional residual capacity (FRC) and compliance of the respiratory system in all patients were markedly reduced. A FRC between 9.3-10.6 ml/kg and compliance between 1.1-1.8 ml/kPa/kg indicated pronounced hypoplasia of the lungs. Doppler flow patterns through the arterial duct were classified into left-to-right, right-to-left and bidirectional shunting and correlated to the degree of PHT. The additional use of PGE1 to reopen the arterial duct and to stabilize right ventricular function led to an amelioration of severe PHT and preoperative stabilisation in 2 newborns with pronounced pulmonary hypoplasia. All patients underwent successful surgery, and did not show any complications after 2 years follow-up.


CONCLUSIONS
Measurements of lung function parameters and adaptation of mechanical ventilation to the degree of pulmonary hypoplasia and additional therapy with PGE1 may help to improve the outcome in CDH patients.
Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany. sigrun.hofmann@uniklinikumdresden.de
S R
SR
Hofmann
K
K
Stadler
A
A
Heilmann
H J
HJ
Häusler
G
G
Fitze
G
G
Kamin
K I
KI
Nitzsche
G
G
Hahn
J
J
Dinger
D000015:Abnormalities, Multiple / Q000503:physiopathology* / Q000628:therapy*; D000465:Algorithms; D000527:Alprostadil / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology / Q000628:therapy; D015150:Echocardiography, Doppler; D005652:Functional Residual Capacity / Q000502:physiology; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006548:Hernia, Diaphragmatic / Q000503:physiopathology / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology* / Q000628:therapy*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000503:physiopathology* / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D008168:Lung / Q000002:abnormalities / Q000503:physiopathology; D008171:Lung Diseases / Q000503:physiopathology* / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology* / Q000628:therapy*
D000527:Alprostadil; D010100:Oxygen