PREOPERATIVE CARDIORESPIRATORY TRENDS IN INFANTS WITH CONGENITAL DIAPHRAGMATIC-HERNIA

The objective of this study was to determine the cardiovascular and pu lmonary adaptations of infants with congenital diaphragmatic hernia (C DH) from birth until delayed surgery through the use of continuous mon itoring. Continuous cardiovascular (HR, heart rate variability [HR-SD] , BP, blood pressure variability [BP-SD], and oxygen saturation) and v entilatory (minute volume, airway pressure, and effective compliance) measurements were made on-line, using a computerized whole-body plethy smograph incubator (Vital-trends, VT1000), in nine ventilated infants with CDH. Data collection commenced at birth and continued until surge ry. Minute mean values for each variable were recorded. Hourly means w ere computed from the minute means, averaged across infants each hour over the first 50 hours of life, and regressed against postnatal age. Results showed a significant increase in BP (P < .01), BP-SD (P < .05) , HR-SD (P < .04), and pH (P < .02) versus postnatal age, and a decrea se in Paco(2) (P < .04), FlO(2) (P < .001), Alveolar-arterial oxygen g radient (P < .003), and oxygenation index (P < .002). Infants with CDH show cardiopulmonary trends over the first 2 days of life that are qu alitatively similar to those of normal newborn infants. Deviation from these idealized patterns may identify an infant who is not responding satisfactorily to the given therapy and who may require alternative t reatment modalities. Copyright (C) 1995 by W.B. Saunders Company