Pre and postductal O2 saturation monitoring
QUIET ENVIROMENT
If patient has hypoxia, consider increasing FiO2, adjusting PEEP.
Consider starting inhaled nitric oxide to decrease pulmonary vascular resistance.
HFOV can be used for both hypercarbia and hypoxia.
If all therapy fails, consider ECMO.NOTE: As these infants are at significant risk for PFC/PPHN, please refer to
PFC/PPHN section for further management details.
Postnatal physiologic measurements were validated to correlate with outcome. The
CDH Study Group developed an equation for predicting survival based on birth weight
and a 5-minute APGAR score. The Canadian Neonatal Network validated the SNAP-II
score as predictive mortality in CDH
Surgical Correction
Operative repair is generally undertaken when infant is physiologically stable
(NEAR extubatable vent settings) However, there are instances when this cannot be
achieved. Some patients may actually have to be repaired on ECMO. Surgical
correction does NOT generally change the physiology of PPHN.
In patients that are physiologically well, a minimally invasive approach
(thoracoscopic or laparoscopic) can be attempted. In these patients, expect a high