title: Neuromuscular blockade and lung function during resuscitation of infants with congenital diaphragmatic hernia.
abstract: BACKGROUND
  There is no consensus or evidence as to whether a neuromuscular blocking agent should be used during the initial resuscitation of infants with congenital diaphragmatic hernia (CDH) in the labour ward.
  
  
  OBJECTIVE
  To determine if administration of a neuromuscular blocking agent affected the lung function of infants with CDH during their initial resuscitation in the labour ward.
  
  
  METHODS
  Fifteen infants with CDH were studied (median gestational age 38 weeks, range 34-41; birth weight 2,790 g, range 1,780-3,976). Six infants had undergone feto-endotracheal occlusion (FETO). Flow, airway pressure, tidal volume and dynamic lung compliance changes were recorded using a respiratory function monitor (NM3, Respironics). Twenty inflations immediately before, immediately after and 5 min after administration of a neuromuscular blocking agent (pancuronium bromide) were analysed.
  
  
  RESULTS
  The median dynamic lung compliance of the 15 infants was 0.22 ml/cm H2O/kg (range 0.1-0.4) before and 0.16 ml/cm H2O/kg (range 0.1-0.3) immediately after pancuronium bromide administration (p < 0.001) and remained at a similar low level 5 min after pancuronium bromide administration. The FETO compared to the non-FETO infants had a lower median dynamic compliance both before (p < 0.0001) and 5 min after pancuronium administration (p < 0.001) and required significantly longer durations of ventilation (p = 0.004), supplementary oxygen (p = 0.003) and hospitalisation (p = 0.007).
  
  
  CONCLUSIONS
  Infants with CDH, particularly those who have undergone FETO, have a low lung compliance at birth, and this is further reduced by administration of a neuromuscular blocking agent.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
authors.forename: Vadivelam
authors.initials: V
authors.lastname: Murthy
authors.forename: Walton
authors.initials: W
authors.lastname: D'Costa
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaides
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
authors.forename: Grenville
authors.initials: G
authors.lastname: Fox
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Milner
authors.forename: Morag
authors.initials: M
authors.lastname: Campbell
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D021721:Balloon Occlusion; D005260:Female; D005315:Fetal Diseases / Q000628:therapy; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000196:embryology / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology*; D008170:Lung Compliance / Q000187:drug effects; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000009:adverse effects*; D010197:Pancuronium / Q000008:administration & dosage / Q000009:adverse effects; D012151:Resuscitation / Q000379:methods*
chemical_list: D009466:Neuromuscular Blocking Agents; D010197:Pancuronium