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

ECMO Indications/Contraindications for Infants with CDH Prior to Repair

Discuss each case with surgical and ECMO Resource Attending to determine candidacy

Indications	Inability to maintain pre ductal saturations > 85% or post-ductal PaO₂ > 30 mmHg Respiratory acidosis unresponsive to maximum ventilatory support Mean airway pressure > 15 Note: if lungs underinflated can try higher mean airway pressure to recruit, then wean as able Refractory systemic hypotension unresponsive to fluid and vasoactive infusions Severe ventricular dysfunction on cardiac Echo unresponsive to medical therapies Inadequate oxygen delivery based on persistent metabolic acidosis or rising serum lactate level Inability to wean FiO₂ below 80% in first week of life with no response to lung lesion dexamethasone if candidate Lung Lesion Dexamethasone Administration Protocol
Relative Contraindications	Weight < 2 kg Significant congenital or chromosomal anomalies Complex congenital heart disease, especially those that result in single-ventricle physiology No response to postnatal resuscitation
Absolute Contraindications	Intracranial hemorrhage ≥ grade III Trisomy 13 and trisomy 18, if diagnosis known prior to ECMO cannulation Gestational age < 32 wks

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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

ECMO Indications/Contraindications for Infants with CDH Prior to Repair

Find a research study

Innovation and your child

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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — ECMO Indications/Contraindications Prior to Repair — Clinical Pathway: Inpatient and ICU

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

ECMO Indications/Contraindications for Infants with CDH Prior to Repair