Fellow Childrens Hospital of Philadelphia Wynnewood, Pennsylvania, United States
Background: Infants with congenital diaphragmatic hernia (CDH) have altered fetal to extrauterine transition due to pulmonary hypoplasia, pulmonary hypertension, and ventricular dysfunction, which may affect cerebral tissue oxygen saturation (crSO2). Cerebral hypoxia has been associated with worse neurologic outcomes in other critically ill infant populations. CrSO2 during postnatal transition has been characterized in non-anomalous infants but not in CDH. To study this association in CDH, crSO2 reference ranges must first be established. Objective: To characterize crSO2 during postnatal transition in infants with CDH. Secondarily, to define oxygen saturation (SpO2), heart rate (HR) and cerebral fractional tissue oxygen extraction (cFTOE) trajectories; and to determine feasibility of near infrared spectroscopy (NIRS) monitoring during delivery room resuscitation. Design/Methods: This is a prospective, observational study of infants >/= 34 weeks gestational age with prenatally diagnosed CDH delivered between 9/2022-12/2023. Infants with prenatally diagnosed neurologic anomalies and significant congenital heart disease were excluded. Physiologic data were continuously collected during the first hour of life, including crSO2 using NIRS placed on the left forehead immediately after birth. Subgroups of interest were defined by CDH sidedness (right vs left), severity (O/E trace < 25% vs >25%), and mode of ventilation. Data will be summarized for minutes of life 1-15, 20, 30, 45, and 60. Locally weighted scatterplot smoothing (LOWESS) curves will be generated to explore the crSO2, SpO2, HR and cFTOE trajectories. This study is approved by the Children’s Hospital of Philadelphia IRB. Timeline: Analysis of the pilot cohort (n=28) is ongoing. Recruitment will continue until 12/2023 at which time final analysis will occur.
