The impact of a care bundle with an emphasis on hemodynamic assessment on the short-term outcomes in neonates with congenital diaphragmatic hernia

Hemodynamic management of congenital diaphragmatic hernia: the role of targeted neonatal echocardiography

“…The implementation of a CDH care bundle emphasizing frequent hemodynamic assessments by targeted neonatal echocardiography (TnECHO) has been shown to improve the short-term outcomes of CDH. 35…”

“…The adoption of bedside TnECHO performed by neonatologists with specialized training marks a significant evolution in neonatal intensive care, particularly in relation to CDH management. 35 The first echocardiogram performed by pediatric cardiology is crucial for assessing the severity of PHT and ventricular function, and for identifying congenital heart disease. After this initial assessment, a team of TnECHO-trained neonatologists provides serial reviews focusing on PHT, cardiac output, and ventricular dysfunction.…”

“…These follow-up evaluations are conducted every 24-48 hours or in response to abrupt or unexplained hemodynamic or respiratory status changes, both prior to and following CDH surgery, continuing until PHT has resolved. 35 Assessments should align with the guidelines provided by leading echocardiography and pediatric cardiology associations such as the American Society of Echocardiography, the European Association of Echocardiography, and the Association for European Pediatric Cardiologists. 45 46 Using either a 6-MHz or 12-MHz high-frequency phased-array transducer probe, these protocols stipulate obtaining a comprehensive suite of images-including standard two-dimensional, M-mode, color Doppler, pulse-wave Doppler, and continuous-wave Doppler-for a thorough transthoracic echocardiographic analysis.…”

“…RV-focused apical threechamber view is acquired to measure RV areas at enddiastole and end-systole to calculate the fractional area change (FAC). 35 Right ventricular output (RVO) is calculated.…”