Assessment of Carina Position Antenatally and Postnatally in Infants with Congenital Diaphragmatic Hernia

Abstract

Cephalad displacement of the carina in infants with CDH may predispose them to right main-stem intubation and subsequent development of pneumothorax. We speculate that modifying the ETT insertion depth to 5.5 cm + weight in newborns born at term may prevent pneumothoraces and improve outcomes for infants with CDH.

Congenital Diaphragmatic Hernia Repair in a Patient With Pallister-Killian Mosaic Syndrome and Left Ventricular Hypoplasia

“…Poor prognostic indicators in infants with CDH include cardiac or chromosomal abnormalities, hepatic herniation, lung area/head circumference ratio (LHR) < 25%, percent predicted lung volume (PPLV) < 15%, total lung volume < 20 mL, LV hypoplasia, and right-sided CDH. Infants with a low PPLV had significantly higher rates of extracorporeal membrane oxygenation (ECMO) use [7][8].…”

Comparison of Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia

“…described a cephalad displacement of the carina both pre-and postnatally. 30 They found that more severe CDH indices were predictors of a shorter distance from the thoracic inlet to the carina. While they proposed using a shallower ETT depth during initial stabilization, 30 this study suggests a deeper depth than current estimates even in our more severe cases.…”