Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Universal Care Before Surgical Repair: IV Access, Lab/Radiology Studies, IVFs, Sump, Consults — Clinical Pathway: Inpatient and ICU

Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Universal Care for Infants with CDH Before Surgical Repair:
IV Access, Lab/Radiology Studies, IVFs, Sump, and Consults

IV Access
  • Arterial
    • UAC or PAL, pre-ductal is preferred
  • Central Venous
    • UVC or double lumen PICC, lower extremity is preferred
  • Peripheral IV
    • May be needed for blood product administration and certain medications
    • Clinical team to discuss with pharmacy
Laboratory Studies Per admission order set
Radiologic Studies
  • Babygram on admission, daily, and PRN
  • Brain ultrasound on admission
  • Echo on admission and as clinically indicated with sedation
IV Fluids
  • Fluid restriction with goal calories
  • Initial fluids
    • Total fluid limit 80-90 mL/kg/day
    • D10W + 2000 mg calcium gluconate per 1,000 mL
  • Total parenteral nutrition and lipids
    • Begin on day of life 0-1
  • Pre-op CDH
    • Advance total fluid limit to meet caloric needs while optimizing
      fluid balance
    • Approximately 110-120 mL/kg/day
Salem Sump™
  • 10-12 Fr based on infant's size
    • Use 10 Fr initially
    • Consider 12 Fr if inadequate bowel gas decompression
  • Place in oropharynx to low, continuous suction
  • Ensure bowel decompression to limit abdominal competition and optimize
    respiratory status
Consults/Care Partners