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

Journal of Perinatology volume 44, pages 348–353 (2024)Cite this article

Subjects

Abstract

Objective

To evaluate the short-term outcomes of implementing a care bundle emphasizing frequent hemodynamic assessments by echocardiography in neonates with congenital diaphragmatic hernia (CDH).

Study design

This was a retrospective cohort study of infants with CDH admitted to a quaternary perinatal unit from January 2013 to March 2021. The primary composite outcome was defined as mortality or use of extracorporeal membrane oxygenation or need for respiratory support at discharge.

Results

We identified 37 and 20 CDH infants in Epoch I and II, respectively. More patch repairs (50% vs. 21.9%, p = 0.035) and echocardiograms (6[4–8] vs. 1[0–5], p = 0.003) were performed in Epoch II. While there were no differences in the primary outcome, there was a reduction in mortality in Epoch II (0% vs. 27%, p = 0.01).

Conclusion

With the implementation of a CDH care bundle with an emphasis on hemodynamic assessment, we demonstrated a significant reduction in mortality.

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Data availability

The database for this research article is not available because of identifiable patient particulars in a relatively small number of patients.

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Acknowledgements

We thank Dr. Alfonso Solimano for his contribution to the implementation of the TnEcho protocol.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Mimi T. Y. Kuan, Krishan Yadav, Michael Castaldo, Natalie H. Chan, Martin Hosking & Joseph Y. Ting

  2. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Jason Tan

  3. Department of Pediatric and Newborn Medicine, UCSF and Benioff Children’s Hospital, San Francisco, CA, USA

    Natalie H. Chan

  4. Department of Anesthesiology, University of British Columbia, Vancouver, BC, Canada

    Michael Traynor

  5. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Erik Skarsgard

  6. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Joseph Y. Ting

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  1. Mimi T. Y. Kuan
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Contributions

MTYK, KY, ES and JYT conceptualized and designed the study. MTYK, KY and JT collected the data. All authors analyzed and interpreted the data. MK and JYT drafted the initial manuscript. All authors critically reviewed and revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Joseph Y. Ting.

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Kuan, M.T.Y., Yadav, K., Castaldo, M. et al. The impact of a care bundle with an emphasis on hemodynamic assessment on the short-term outcomes in neonates with congenital diaphragmatic hernia. J Perinatol 44, 348–353 (2024). https://doi.org/10.1038/s41372-023-01807-0

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