Purpose: To evaluate the effectiveness of a novel protocol, adopted in our institution, for improving outcomes of congenital diaphragmatic hernia (CDH) Mehtods: A maximal lung protection (MLP) protocol was implemented in 2019. This strategy included immediate use of high frequency oscillatory ventilation (HFOV) after birth, during stay at the Neonatal Intensive Care Unit (NICU) and during surgical repair. HFOV strategy included low distending pressures and higher frequencies (15 Hz) with subsequent lower tidal volumes. Surgical repair was performed early, within 24 hours of birth, if possible.A retrospective study of all inborn neonates prenatally diagnosed with CDH and without major associated anomalies was performed at the NICU of Schneider Children's Medical Center of Israel between 2009 and 2022. Survival rates and pulmonary outcomes of neonates managed with MLP were compared to standard care.Results: 33 neonates were managed with the MLP protocol vs. 39 neonates that were not. Major adverse outcomes decreased including death rate from 46% to 18% (p= 0.012), extracorporeal membrane oxygenation from 39% to 0% (p<0.001) and pneumothorax from 18% to 0% (p=0.013).
Conclusion(s): MLP with early surgery signi cantly improved survival and additional adverse outcomes of neonates with CDH. Prospective randomized studies are necessary to con rm the ndings of the current study.
What is KnownVentilator induced Lung Injury was reported as the main cause of mortality in neonates with congenital diaphragmatic hernia (CDH) Conventional ventilation was recommended by the European CDH consortium as rst line ventilation modality Timing for surgery is controversial What is new A maximal lung protection strategy based on 15 hertz high frequency oscillatory ventilation with low distending pressures as initial modality and early surgery signi cantly reduced mortality and other outcomes.