title: Resuscitation of infants with congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To determine whether the respiratory response to resuscitation in infants with congenital diaphragmatic hernia (CDH) as measured by a respiratory function monitor differed between those who did and did not survive.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Tertiary perinatal centre.
  
  
  METHODS
  Thirty-eight infants born at 34 weeks of gestation or greater and diagnosed antenatally with a CDH.
  
  
  METHODS
  Expiratory tidal volume (VTe), peak inflation pressure (PIP) and end-tidal carbon dioxide level (ETCO2) were simultaneously recorded during resuscitation using a respiratory function monitor. Oxygen saturation was also monitored.
  
  
  METHODS
  Mortality related to the median VTe, PIP, compliance (VTe divided by PIP) and ETCO2levels in the first and last minute of recorded resuscitation and the maximum oxygen saturation.
  
  
  RESULTS
  The median gestational age, birth weight and duration of resuscitation of the 11 infants who died did not differ significantly from those who survived. During the first minute of recorded resuscitation, the VTe (median 1.89 vs 2.68 mL/kg) (p=0.009)), the ETCO2(median 11.7 vs 41.7 mm Hg) (p=0.023)) and the compliance (0.06 vs 0.08 mL/cm H2O/kg) (p=0.018)) were lower in the non-survivors. In the last minute, the PIP was higher (32.5 vs 30.3 cm H2O) (p=0.03)), the VTe (3.22 vs 4.66 mL/kg) (p=0.003)) and compliance (0.10 vs 0.15 mL/cm H2O/kg) (p=0.004)) were lower in the non-survivors. The maximum oxygen saturation achieved in the labour suite was lower in the non-survivors (93% vs 100%) (p=0.037).
  
  
  CONCLUSIONS
  Infants with CDH who did not survive responded less well even to initial resuscitation.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: O'Rourke-Potocki
authors.affiliation: Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Kamal
authors.initials: K
authors.lastname: Ali
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
authors.forename: Vadivelam
authors.initials: V
authors.lastname: Murthy
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Milner
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.|National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D005260:Female; D005540:Forced Expiratory Flow Rates / Q000502:physiology; D065630:Hernias, Diaphragmatic, Congenital / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008170:Lung Compliance / Q000502:physiology*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D012123:Pulmonary Ventilation / Q000502:physiology*; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology; D012151:Resuscitation / Q000379:methods*; D013990:Tidal Volume
keywords: Congenital diaphragmatic hernia; Resuscitation; compliance