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

Discharge Readiness and Preparation

Achieve or complete the following

Neurology	Stable off all sedation, minimum of 48-72 hrs
Respiratory	Off respiratory support or on home respiratory regimen for greater than 72 hrs Obtain baseline CXR and provide copy to family At stable on diuretic dose for discharge Ideally, dose not changed or discontinued within 7 days prior to discharge High altitude simulation testing, if indicated Pulmonary involvement in discharge plan Any home respiratory support Home diuretic management if for respiratory indication In flight oxygen requirement
Cardiovascular	Repeat Echo, as indicated Outpatient follow-up interval determined PH medications, if indicated Orders completed by PH team Specialty pharmacy identified Prior authorization obtained Medications delivered to parent Bedside treprostinil education completed, if indicated Cardiology involvement in discharge plan Home diuretic management if for cardiac indication
GI/Nutrition	Consistent, adequate, age-appropriate weight gain for several days Outpatient speech therapy plan identified for those requiring tube feeds Tube feeds, ideally gastric route over 30 mins All other feeding plans require thorough discussion/approval Stable GERD symptoms No desaturation/bradycardia events with safe sleep environment, head of bed flat Medication prior authorization obtained if needed
Immunizations	Standard immunizations per age Administer RSV prophylaxis before discharge, if eligible
Audiology	ABR/OAE screening prior to discharge Follow-up per audiology recommendation
Family Education	All classes and bedside teaching completed Parents are independent and comfortable with care at the bedside
General	Newborn screen and required follow-up complete Pediatrician Identified Appointment scheduled for 1-3 days after discharge Insurance Coverage Identified Outpatient PHP follow-up, as indicated Outpatient follow-up coordinated for each specialty Early intervention referral Prescriptions picked up Birth certificate provided to admissions to update name, as needed As Indicated DME identified and supplies delivered Home nursing coordinated Car seat study

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

Discharge Readiness and Preparation

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

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

Discharge Readiness and Preparation