Team-based care with early recognition and treatment of cardiac dysfunction for infants with CDH

Abstract Objective Identify how a core congenital diaphragmatic hernia (CDH) team coupled with early recognition and treatment of cardiac dysfunction changed outcomes for infants with CDH. Methods A retrospective chart review compared a historical cohort from 2015–2019 (n = 51) with a post-guideline cohort from 2020–2025 (n = 53). Statistical analysis was performed with Fisher’s exact, unpaired t-test, and Mann Whitney U-test. Results Survival improved from 68.6% to 88.7% ( p  = 0.016) and ECMO utilization decreased, 51.0% to 26.4% ( p  = 0.015). Infants with cardiac dysfunction had increased survival (47.3% vs. 81.8%, p  = 0.014) and less ECMO utilization (68.4% vs. 36.3%, p  = 0.043). Vasoactive choices evolved with dopamine replaced by norepinephrine, low-dose epinephrine, or calcium gluconate. Inhaled nitric oxide (iNO) use in the first 48 hours decreased significantly while prostaglandin E1 (PGE1) use increased. Discussion We implemented a core CDH team focused on a generalizable, physiology-driven approach to identify and treat cardiac dysfunction using standard neonatal echocardiography to improve outcomes.