Abstract
Background: There is no consensus or evidence as to whether a neuromuscular blocking agent should be used during the initial resuscitation of infants with congenital diaphragmatic hernia (CDH) in the labour ward.
Objective: To determine if administration of a neuromuscular blocking agent affected the lung function of infants with CDH during their initial resuscitation in the labour ward.
Methods: Fifteen infants with CDH were studied (median gestational age 38 weeks, range 34-41; birth weight 2,790 g, range 1,780-3,976). Six infants had undergone feto-endotracheal occlusion (FETO). Flow, airway pressure, tidal volume and dynamic lung compliance changes were recorded using a respiratory function monitor (NM3, Respironics). Twenty inflations immediately before, immediately after and 5 min after administration of a neuromuscular blocking agent (pancuronium bromide) were analysed.
Results: The median dynamic lung compliance of the 15 infants was 0.22 ml/cm H(2)O/kg (range 0.1-0.4) before and 0.16 ml/cm H(2)O/kg (range 0.1-0.3) immediately after pancuronium bromide administration (p <0.001) and remained at a similar low level 5 min after pancuronium bromide administration. The FETO compared to the non-FETO infants had a lower median dynamic compliance both before (p <0.0001) and 5 min after pancuronium administration (p <0.001) and required significantly longer durations of ventilation (p = 0.004), supplementary oxygen (p = 0.003) and hospitalisation (p = 0.007).
Conclusions: Infants with CDH, particularly those who have undergone FETO, have a low lung compliance at birth, and this is further reduced by administration of a neuromuscular blocking agent.
Objective: To determine if administration of a neuromuscular blocking agent affected the lung function of infants with CDH during their initial resuscitation in the labour ward.
Methods: Fifteen infants with CDH were studied (median gestational age 38 weeks, range 34-41; birth weight 2,790 g, range 1,780-3,976). Six infants had undergone feto-endotracheal occlusion (FETO). Flow, airway pressure, tidal volume and dynamic lung compliance changes were recorded using a respiratory function monitor (NM3, Respironics). Twenty inflations immediately before, immediately after and 5 min after administration of a neuromuscular blocking agent (pancuronium bromide) were analysed.
Results: The median dynamic lung compliance of the 15 infants was 0.22 ml/cm H(2)O/kg (range 0.1-0.4) before and 0.16 ml/cm H(2)O/kg (range 0.1-0.3) immediately after pancuronium bromide administration (p <0.001) and remained at a similar low level 5 min after pancuronium bromide administration. The FETO compared to the non-FETO infants had a lower median dynamic compliance both before (p <0.0001) and 5 min after pancuronium administration (p <0.001) and required significantly longer durations of ventilation (p = 0.004), supplementary oxygen (p = 0.003) and hospitalisation (p = 0.007).
Conclusions: Infants with CDH, particularly those who have undergone FETO, have a low lung compliance at birth, and this is further reduced by administration of a neuromuscular blocking agent.
| Original language | English |
|---|---|
| Pages (from-to) | 112-117 |
| Number of pages | 6 |
| Journal | Neonatology |
| Volume | 103 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2013 |
Keywords
- VENTILATED NEWBORN-INFANTS
- Congenital diaphragmatic hernia
- PULMONARY INTERSTITIAL EMPHYSEMA
- RATIO
- SURVIVAL
- PREDICTION
- Resuscitation
- VOLUME
- Neuromuscular blockade
- BABIES
- Lung compliance
- Tidal volume
- PARALYSIS
- MATURATION