Inpatient and N/IICU Clinical Pathway for the Pre and Post-operative Care
of the Infant with Congenital Diaphragmatic Hernia (CDH)
Admit to Neonatal Surgical Service in N/IICU
Enter Neonatology CDH Order Set
Universal Care for all Infants Prior to Repair
Care for Newborn with Preductal Oxygen
Saturation < 85% or Hypotension or Acidosis
on presentation or decompensation before repair
Saturation < 85% or Hypotension or Acidosis
on presentation or decompensation before repair
Adequate response
to interventions
to interventions
Inadequate response
to interventions
to interventions
Care Escalation
- Notify surgical fellow and
neonatology attending - Notify blood bank re: potential ECMO
- Ensure airway patent, adequate sedation and bowel decompression
- ECMO Indications/Contraindications
ECMO Management
- Bedside Nursing
- Managing CDH Infants on ECMO
- Continue Universal Care (see above)
- Decannulation Readiness
- Decannulation
Daily Interdisciplinary Assessment
Schedule repair when physiologic goals metor as clinically indicated
- Sedation
- Pulmonary hypertension
- Respiratory support
- Nutrition
- GERD
- Preparing to hold baby
Posted: March 2024
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team
Evidence
- Diagnosis and Management of Congenital Diaphragmatic Hernia: a Clinical Practice Guideline
- Ventilation Strategies During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure: Current Approaches Among Level IV Neonatal ICUs
- Update on Management and Outcomes of Congenital Diaphragmatic Hernia
CHOP Programs
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment
- Pulmonary Hypoplasia Program
- Garbose Family Special Delivery Unit
- Martha Escoll Lubeck Feeding and Swallowing Center