Steven Fenton

23 statements · 1 topic

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Among CDH cases with MRI total fetal lung volume observed-to-expected less than 15%, ECMO utilization was 38% rather than the expected 100%
clinical · Congenital Diaphragmatic Hernia
The protocol minimizes stimulation, uses sedation, and does not perform echocardiography within the first 24 hours if prenatal echo exists
clinical · Congenital Diaphragmatic Hernia

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Steven's statements about Congenital Diaphragmatic Hernia 23 statements

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IFMSS 2019 Clinical Studies

Statement Primary Children's Hospital ECMO program was established in 2003, with first CDH protocol implemented in 2007 Open
Statement The 2016 CDH protocol change places infants on high frequency oscillator immediately after intubation with decreased mean airway pressure Open
Quotation for the 1st 72 hours, we're going to put the baby in a corner Open
Quotation what I mean by putting baby in a corner is the child, uh, our delivery ORs are, is right next to uh what we would term our birthing NICU Open
Quotation we put them in a, in a, a, a place of the NICU that's quiet Open
Statement The protocol minimizes stimulation, uses sedation, and does not perform echocardiography within the first 24 hours if prenatal echo exists Open
Statement Oxygen management is based on preductal saturations only, with no routine postductal saturation monitoring Open
Statement Oxygen resuscitation starts at FIO2 of 0.4 instead of 1.0 Open
Statement Inhaled nitric oxide and other vasodilators or pressor agents are used only for clinically significant hypoperfusion Open
Statement Median mean airway pressure decreased from 13 to 11 after protocol implementation Open
Statement Higher mean airway pressure compromises gas exchange and lung vascularization, potentially increasing pulmonary hypertension Open
Statement The protocol is applied to all prenatally diagnosed CDH cases regardless of severity Open
Statement ECMO utilization rate decreased from 37% to 13% after protocol implementation Open
Statement Overall survival rate increased from 74% to 89% after protocol implementation Open
Statement Survival improvement was statistically significant for liver-down CDH cases Open
Statement Survival increased for liver-up CDH cases but was not statistically significant Open
Statement Since 2016, 97% of CDH cases received prenatal MRI compared to 24% before the fetal center was established Open
Statement In the study period since 2016, there were 53 isolated left CDH cases after exclusions Open
Statement Among CDH cases with MRI total fetal lung volume observed-to-expected less than 15%, ECMO utilization was 38% rather than the expected 100% Open
Statement ECMO criteria include PAO2 never rising above 50 and inability to get CO2 levels below 100 Open
Statement The MRI less than 15% group had 50% survival Open
Statement The CDH protocol is implemented by the entire neonatology group, not individual providers Open
Statement Changing clinical culture was one of the hardest aspects of implementing the protocol Open