Researchers from the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) at Children’s Hospital of Philadelphia (CHOP) found that survival rates in infants with congenital diaphragmatic hernia (CDH) improved over time even in the most serious cases due to ongoing experience and continuous review of outcomes. The findings were published in the Journal of Perinatology.
In babies with CDH, a severe birth defect where a hole in the diaphragm lets abdominal contents enter the chest, there isn't enough room for the lungs to develop properly before birth. In the most severe cases, CDH can lead to life-threatening problems at birth. The concept of the “golden hour,” the first hour after delivery, initially applied to care for premature babies when fast, well-planned care was found to make a significant difference in survival. However, the concept of a golden hour of stabilization can also be applied to infants with complex congenital anomalies like CDH where the goal is to rapidly stabilize an infant with critical interventions.
Since large clinical trials for CDH are rare, most guidelines rely on expert experience and observation. In this retrospective single center study, researchers at CHOP evaluated 454 babies born with CDH over 15 years of care (from 2008 to 2023) in CHOP’s Garbose Family Special Delivery Unit, the first birth center in a children’s hospital designed specifically for babies with birth defects. Their goal was to see how golden hour strategies have evolved and how they’ve helped improve outcomes for high-risk newborns. Each year, there are approximately 500 deliveries in the SDU, including about 50 infants with CDH.
“While we still need more research, analyzing real-time data helps us make informed, evidence-based decisions to give every baby the chance to thrive,” said K. Taylor Wild, MD, the study’s lead author and an attending physician with the Division of Neonatology at Children's Hospital of Philadelphia.
The researchers divided the 15-year timeline into three time periods: 2008-2013, 2014-2018 and 2019-2023. They reviewed what treatments were used during each period, as well as how many newborns survived, how many needed ECMO and what procedures were done in the delivery room.
The study showed that, over time, newborns received less oxygen at birth to avoid lung damage. High frequency ventilators were incorporated into treatment to help babies breathe more gently and to improve respiratory outcomes. Care plans were personalized based on the severity of the newborn’s condition and there was significantly more training to help the multidisciplinary team monitor babies in real-time.
As a result, researchers found that survival rates improved from 71 percent in the earliest cohort to 83 percent is the most recent cohort. More newborns had surgery to address their CDH, and even though prenatal prognostic indicators reflected more severe CDH, outcomes still improved and the use of ECMO remained consistent.
“Our significant strides come from our commitment to learning and refining, taking the wisdom we’ve gleaned and evolving at every turn,” said Holly Hedrick, MD, a senior study author and pediatric and fetal surgeon in the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP.
Wild et al. “Golden hour management of infants with congenital diaphragmatic hernia: 15-year experience at a high-volume center.” J Perinatol. Online February 21, 2025. DOI: 10.1038/s41372-025-02226-z.
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Researchers from the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) at Children’s Hospital of Philadelphia (CHOP) found that survival rates in infants with congenital diaphragmatic hernia (CDH) improved over time even in the most serious cases due to ongoing experience and continuous review of outcomes. The findings were published in the Journal of Perinatology.
In babies with CDH, a severe birth defect where a hole in the diaphragm lets abdominal contents enter the chest, there isn't enough room for the lungs to develop properly before birth. In the most severe cases, CDH can lead to life-threatening problems at birth. The concept of the “golden hour,” the first hour after delivery, initially applied to care for premature babies when fast, well-planned care was found to make a significant difference in survival. However, the concept of a golden hour of stabilization can also be applied to infants with complex congenital anomalies like CDH where the goal is to rapidly stabilize an infant with critical interventions.
Since large clinical trials for CDH are rare, most guidelines rely on expert experience and observation. In this retrospective single center study, researchers at CHOP evaluated 454 babies born with CDH over 15 years of care (from 2008 to 2023) in CHOP’s Garbose Family Special Delivery Unit, the first birth center in a children’s hospital designed specifically for babies with birth defects. Their goal was to see how golden hour strategies have evolved and how they’ve helped improve outcomes for high-risk newborns. Each year, there are approximately 500 deliveries in the SDU, including about 50 infants with CDH.
“While we still need more research, analyzing real-time data helps us make informed, evidence-based decisions to give every baby the chance to thrive,” said K. Taylor Wild, MD, the study’s lead author and an attending physician with the Division of Neonatology at Children's Hospital of Philadelphia.
The researchers divided the 15-year timeline into three time periods: 2008-2013, 2014-2018 and 2019-2023. They reviewed what treatments were used during each period, as well as how many newborns survived, how many needed ECMO and what procedures were done in the delivery room.
The study showed that, over time, newborns received less oxygen at birth to avoid lung damage. High frequency ventilators were incorporated into treatment to help babies breathe more gently and to improve respiratory outcomes. Care plans were personalized based on the severity of the newborn’s condition and there was significantly more training to help the multidisciplinary team monitor babies in real-time.
As a result, researchers found that survival rates improved from 71 percent in the earliest cohort to 83 percent is the most recent cohort. More newborns had surgery to address their CDH, and even though prenatal prognostic indicators reflected more severe CDH, outcomes still improved and the use of ECMO remained consistent.
“Our significant strides come from our commitment to learning and refining, taking the wisdom we’ve gleaned and evolving at every turn,” said Holly Hedrick, MD, a senior study author and pediatric and fetal surgeon in the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP.
Wild et al. “Golden hour management of infants with congenital diaphragmatic hernia: 15-year experience at a high-volume center.” J Perinatol. Online February 21, 2025. DOI: 10.1038/s41372-025-02226-z.
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Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment