“…A dynamic randomization procedure using the Pocock and Simon minimization method is used [ 22 ]. Whatever the group of randomization, the national guidelines [ 23 , 24 ] for resuscitation maneuvers in the delivery room will be applied similarly in both groups. Except the timing of cord clamping, the overall management including the resuscitation maneuvers in the delivery room (intact cord resuscitation group) or resuscitation room (early cord clamping group), and organization of the follow-up will be similar in both groups.…”
Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta.
“…A dynamic randomization procedure using the Pocock and Simon minimization method is used [ 22 ]. Whatever the group of randomization, the national guidelines [ 23 , 24 ] for resuscitation maneuvers in the delivery room will be applied similarly in both groups. Except the timing of cord clamping, the overall management including the resuscitation maneuvers in the delivery room (intact cord resuscitation group) or resuscitation room (early cord clamping group), and organization of the follow-up will be similar in both groups.…”
Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta.
“…13 Sedation with intravenous medications to decrease physiologic stress during intubation and mechanical ventilation are part of some protocols and necessary in most patients. 6 The European Consortium does not recommend neuromuscular blockade and considers chemical paralysis to be contraindicated. 16 Sur et al, 14 however, found that immediate administration of medications for sedation and paralysis decreased the instance of pneumothorax.…”
Section: Search Strategymentioning
confidence: 99%
“…VILI increases the risk of pulmonary complications in this population, which can be seen in real time. 6 To reduce this risk, it has become a common practice to employ "gentle ventilation" strategies including pressure-targeted conventional ventilation, highfrequency ventilation, or extracorporeal membrane oxygenation (ECMO). 7 In spite of this, support required to sustain life prior to repair can induce VILI that exacerbates respiratory failure, complicates the timing of repair, or contributes to the need for ECMO prior to repair, increasing the risk for death.…”
Congenital diaphragmatic hernia (CDH) is a life-threatening congenital malformation, in which the diaphragm fails to form completely during fetal life allowing abdominal contents to enter the chest. Pulmonary hypoplasia and pulmonary hypertension resulting from changes in the pulmonary vessel muscular layers are the primary effectors of the hypoxic physiology encountered in CDH. Approximately 80% of these malformations occur on the left side and can include migration of the stomach, small and large intestine, portions of the liver and spleen into the left thoracic cavity. Defects of the right diaphragm are less common and may involve presence of the liver as well as the small and
“…A review by Storme et al. describes how organising health care and implementing a nationwide protocol were key factors for reducing mortality and morbidity from CDH in France .…”
Section: Key Factors For Reducing Mortality and Morbidity Due To Congmentioning
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