Snoek Kitty G, Reiss Irwin K M, Greenough Anne, Capolupo Irma, Urlesberger Berndt, Wessel Lucas, Storme Laurent, Deprest Jan, Schaible Thomas, van Heijst Arno, Tibboel Dick
Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Neonatology. 2016;110(1):66-74. doi: 10.1159/000444210. Epub 2016 Apr 15.
In 2010, the congenital diaphragmatic hernia (CDH) EURO Consortium published a standardized neonatal treatment protocol. Five years later, the number of participating centers has been raised from 13 to 22. In this article the relevant literature is updated, and consensus has been reached between the members of the CDH EURO Consortium. Key updated recommendations are: (1) planned delivery after a gestational age of 39 weeks in a high-volume tertiary center; (2) neuromuscular blocking agents to be avoided during initial treatment in the delivery room; (3) adapt treatment to reach a preductal saturation of between 80 and 95% and postductal saturation >70%; (4) target PaCO2 to be between 50 and 70 mm Hg; (5) conventional mechanical ventilation to be the optimal initial ventilation strategy, and (6) intravenous sildenafil to be considered in CDH patients with severe pulmonary hypertension. This article represents the current opinion of all consortium members in Europe for the optimal neonatal treatment of CDH.
2010年，欧洲先天性膈疝（CDH）联盟发布了一份标准化的新生儿治疗方案。五年后，参与中心的数量从13个增加到了22个。在本文中，相关文献得到了更新，并且欧洲先天性膈疝联盟的成员之间达成了共识。关键的更新建议如下：（1）在孕周39周后于大型三级中心进行计划性分娩；（2）在产房初始治疗期间避免使用神经肌肉阻滞剂；（3）调整治疗以使导管前饱和度达到80%至95%，导管后饱和度>70%；（4）将目标动脉血二氧化碳分压设定在50至70毫米汞柱之间；（5）传统机械通气作为最佳初始通气策略，以及（6）对于患有严重肺动脉高压的CDH患者可考虑使用静脉注射西地那非。本文代表了欧洲所有联盟成员对于CDH新生儿最佳治疗的当前观点。
