Fig. 7

Management of CDH – At birth infants with CDH or suspected CDH should have an orogastric/nasogastric tube with suction to attain bowel decompression. Bag-mask ventilation should be avoided. The majority of these infants (especially with prenatal diagnosis of CDH) require intubation in the delivery room. A pre-ductal pulse oximeter is placed on the right upper extremity as soon as possible. Oxygen saturation targets are based on NRP guidelines. Ventilation using a T-piece resuscitator is preferred to avoid high airway pressures. Ventilator parameters are as shown in the figure. Preductal blood gases and invasive blood pressure monitoring are preferred. Inhaled nitric oxide is often used for the management of PPHN. For blood pressure management, fluid boluses and vasopressor agents are used based on the parameters in the figure. (Copyright Satyan Lakshminrusimha)