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

Management of the CDH Infant on VA ECMO

Goal Physiologic Parameters	MAP 40-50 mmHg, Management of Hypertension in the Neonatal ECMO Patient Job Aid PaO₂ 60-80 mmHg CO₂ 45-55 mmHg SvO₂ 65-80% Note: Individualize based on gestational age and clinical status
Anticoagulation	Neonatal Anticoagulation Guideline
Imaging	Daily brain ultrasound Daily babygram
Ventilation	Transition to SIMV-PC after cannulation Initial Settings “Open lung” strategy SIMV-PC PIP 23-25/ PEEP 5-7 x 20, iTime 0.5- 0.7, FiO2 0.3 Traditional “rest settings” 20/10 x 10 +10, iTime 1.0, FiO2 0.3 Nitric Oxide Continue if lungs stay open and infant was an “iNO responder” Restart when lungs open and pulmonary hypertension not resolved
Fluid Management	Goal: Avoid edema/positive fluid balance with fluid restriction, SCUF, and diuresis TFL 80-100 mL/kg/day Optimize nutrition pre-repair, 90-100 kcal/kg/day Slow Continuous Ultrafiltration Initiate 1:1 for blood products Special consideration: basal rate Diuresis Furosemide infusion Initial dose: 0.04 mg/kg/hr (1 mg/kg/day) Advance to achieve effect Note: Diuresis may affect anticoagulation

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

Management of the CDH Infant on VA ECMO

Find a research study

Innovation and your child

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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Management of the CDH Infant on VA ECMO — Clinical Pathway: Inpatient and ICU

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

Management of the CDH Infant on VA ECMO