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

Care for Newborn with Preductal Oxygen Saturation < 85% or Hypotension or Acidosis

  • Babygram
    • Correct ETT placement
    • Optimal inflation, avoid atelectasis and hyperinflation
    • Rule out pneumothorax
    • Salem Sump position and function, adequate bowel decompression
  • Echo
    • If cardiac dysfunction, consider need for vasoactive infusion(s) and correction of metabolic acidosis with sodium bicarbonate bolus over 30 mins and/or sodium acetate infusion
    • If heart underfilled, consider volume IV fluid bolus with NS or LR and optimize
      hemoglobin ≥ 12 g/dL
  • Adjust ventilator based on ABG
    • Consider straight suction if inline suction of ETT is inadequate to clear secretions
    • Consider repositioning infant, unaffected side up and/or neutral neck extension with shoulder roll
    • If inconsistent ventilation, consider evaluation for airway anomaly
  • Assess if sedation is adequate
  • Ensure appropriate access
    • Repeat labs PRN
  • Consider neuromuscular blocking agent
  • Consider sepsis evaluation
  • Brain ultrasound
    • On admission and PRN for decompensation or possible ECMO