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

Ongoing Post-operative Management Through Discharge

Sedation	Discuss Weaning infusions at 48 hrs or once stable post-operatively Consult Clinical Pharmacy for sedation wean/ enteral conversion plan when able
Respiratory Support	Discuss Daily weans to respiratory support (ventilator and non-invasive) Consider decreasing interval of blood gases Need for diuretics Need for steroids Lung Lesion Dexamethasone Administration Protocol Consider acid blockade during steroid course Consult PHP pulmonary team for ongoing respiratory support beyond post-op day 30
Neurology	Imaging (ideal time 44 wks post-menstrual age) Brain MRI without contrast for all infants, unsedated if extubated Consult Neuro 1st cnslt for N/IICU-CICU via Epic secure chat to review MRI results
Pulmonary Hypertension	Trend BNP every Monday and PRN Echocardiogram as clinically indicated Initiate/wean medications in conjunction with PH team Pulmonary vasoactive infusions iNO Enteral medications
Nutrition and Reflux Management	Enteral Feeding Initiation of Enteral Feed in CDH Patients Consider anatomical imaging and discuss potential surgical intervention if: Unable to transition to gastric feeds after 6 wks of enteral feeding Failure of medical management for reflux Monitor weight gain, linear growth, and malnutrition status Medications Judicious use of histamine H2 antagonist and proton pump inhibitor if: Gastric pH not within acceptable range or evidence of gastritis, consider max dose 3 mg/kg/day of omeprazole Discuss motility agent with surgeon prior to initiating Consider bowel regimen if not stooling consistently
Early Mobility	Holding and Mobility Guideline in the N/IICU Preparing to Hold Your Baby in Intensive Care

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

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

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.

Find a research study

Innovation and your child

Find research studies

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

Ongoing Post-operative Management Through Discharge

Find a research study

Innovation and your child

Find research studies

Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Ongoing Post-operative Management Through Discharge — Clinical Pathway: Inpatient and ICU

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

Ongoing Post-operative Management Through Discharge