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

Post-operative Management after CDH Repair

Immediate Priorities

Monitor for cardiorespiratory stability and adequate pain control

Clinical Assessment	Obtain babygram ETT and sump may be malpositioned post-operatively Expect to see air ex vacuo in thorax Follow clinically unless evidence of tension physiology Trend gases every 1-2 hrs Adjust ventilation carefully post-operatively — caution over-weaning Increase post-operative pain management using Newborn/Infant Perioperative Pain Pathway Order Set To consider increasing baseline sedation infusions Monitor fluid balance, assess I/O every 4 hrs Follow drain/chest tube output if applicable Beware of worsening pulmonary hypertension, systemic hypotension, metabolic/respiratory acidosis, decreased urine output and treat appropriately Monitor for Abdominal Compartment Syndrome
Nursing Interventions	Post-operative CDH nursing standards are outlined in the Neonatal Surgical Nursing Care Guideline: Congenital Diaphragmatic Hernia and include: Vital signs and assessment Pain management Patient care Silo Management — Care Considerations Secure silo with trach string, attached to silo bar in bed, to keep silo contents perpendicular to the infant with minimal tension on silo Make sure warmer bed/isolette is in flat position Care of the base and skin Be mindful of leakage Consider Xeroform and cling at base Emergency dislodgement plan Notify FLC/surgical fellow ASAP Monitor for blood accumulation in silo, higher risk on ECMO Discuss infant positioning/silo, strict bedrest Ongoing assessment of perfusion of the bowel Silo positioning Monitor for Abdominal Compartment Syndrome

Clinical Assessment

Obtain babygram
- ETT and sump may be malpositioned post-operatively
- Expect to see air ex vacuo in thorax
  - Follow clinically unless evidence of tension physiology
Trend gases every 1-2 hrs
- Adjust ventilation carefully post-operatively — caution over-weaning
Increase post-operative pain management using Newborn/Infant Perioperative Pain Pathway Order Set
- To consider increasing baseline sedation infusions
Monitor fluid balance, assess I/O every 4 hrs
- Follow drain/chest tube output if applicable
Beware of worsening pulmonary hypertension, systemic hypotension, metabolic/respiratory acidosis, decreased urine output and treat appropriately
Monitor for Abdominal Compartment Syndrome

Nursing Interventions

Post-operative CDH nursing standards are outlined in the Neonatal Surgical Nursing Care Guideline: Congenital Diaphragmatic Hernia and include:
- Vital signs and assessment
- Pain management
- Patient care

Silo Management — Care Considerations
- Secure silo with trach string, attached to silo bar in bed, to keep silo contents perpendicular to the infant with minimal tension on silo
  - Make sure warmer bed/isolette is in flat position
- Care of the base and skin
  - Be mindful of leakage
  - Consider Xeroform and cling at base
- Emergency dislodgement plan
  - Notify FLC/surgical fellow ASAP
- Monitor for blood accumulation in silo, higher risk on ECMO
  - Discuss infant positioning/silo, strict bedrest
  - Ongoing assessment of perfusion of the bowel
- Silo positioning
- Monitor for Abdominal Compartment Syndrome

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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

Post-operative Management after CDH Repair

Immediate Priorities

Find a research study

Innovation and your child

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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Post-operative Management after CDH Repair — Clinical Pathway: Inpatient and ICU

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

Post-operative Management after CDH Repair

Immediate Priorities