Presented at the Neonatal Society 2006 Spring Meeting.
Kamlin COF1, O’Donnell CPF1, Stewart MJ1,2, Davis PG1, Morley CJ1
1 Royal Women’s Hospital, Melbourne, Australia
2 Royal Children’s Hospital, Melbourne, Australia
Background: Gentle ventilation strategies to minimise volutrauma have improved survival in infants with CDH. Most infants are intubated in the DR but data on DR ventilation of infants with CDH is minimal.
Objective: To describe the DR management of antenatally diagnosed CDH
Design/Methods: The Human Research and Ethics Committees of the Royal Women’s Hospital approved studies of neonatal resuscitation. Video and physiological recordings from infants with CDH born between January 2004 and September 2005 were reviewed. Video recordings were made using a camera mounted on the resuscitaire. Operators aimed to achieve minimal chest movement and oxygen saturations (SpO2) 85%. Flow integrated tidal volume (VT) was measured using a flow sensor connected to a Florian respiratory monitor placed between the manual ventilation device (Neopuff) and the ETT. Data are presented as either mean (SD) or median (range).
Results: In the time period there were 12 liveborn infants with antenatally diagnosed CDH; data from 6 infants with video and respiratory function monitoring are presented. Mean GA, BW and median 5 minute Apgar were 38.6 (2.1) wk, 3105 (622) g and 9 (5-10) respectively. All infants gasped at birth. None received mask ventilation and all were electively intubated and ventilated using 100% oxygen. Duration of the first intubation attempt was 36 (23-90) secs. Preductal SpO2at 5 and 10 minutes were 75 (43-93)% and 93 (80-100)%. The first 100 inflations (table) were summarised as means (SD). VTs were greater when spontaneous breathing was noted during manual inflations. The first arterial blood gas, at a mean age of 66 (27) mins with an FiO2 of 0.56 (0.36) showed a mean pH and pCO2 of 7.16 (0.13) and 69.2 (19.1) mmHg respectively. All infants underwent elective repair and survived to discharge home.
Conclusions: It is possible and potentially useful to monitor infants with CDH in the DR. VTs achieved were smaller than those used in other neonatal pathologies with correspondingly higher CO2 levels. Further studies are required to optimise management of these infants in the DR.