Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Children's Hospital Colorado, 13121 E. 17th Avenue, MS 8402, Room 4304, Aurora, CO 80045, USA.
Semin Perinatol. 2023 Jun;47(4):151746. doi: 10.1016/j.semperi.2023.151746. Epub 2023 Mar 17.
Congenital diaphragmatic hernia (CDH) is a severe birth anomaly where a defect in the diaphragm allows abdominal organs to herniate into the chest with compression of the intrathoracic structures, specifically the lungs and heart. Pulmonary and left ventricular hypoplasia result in respiratory insufficiency after birth with disordered transition and persistent pulmonary hypertension of the newborn (PPHN). As a result, infants need immediate intervention after birth to support the transition. Delayed cord clamping (DCC) is recommended for all healthy newborns and improves outcomes in infants born preterm and in infants with congenital heart disease; however, DCC may not be feasible in newborns needing immediate intervention after birth. Recent studies have explored resuscitation with intact umbilical cords, to determine feasibility, safety, and efficacy in infants with CDH, with promising results. In this report we discuss the physiologic basis for intact cord resuscitation in infants with CDH and review the above reports with a view to determining optimal timing of umbilical cord clamping in infants with CDH.
先天性膈疝 (CDH) 是一种严重的出生缺陷，膈膜的缺陷导致腹部器官疝入胸腔，导致胸腔内结构受压，特别是肺部和心脏。肺和左心室发育不良导致出生后呼吸功能不全，出现新生儿呼吸窘迫综合征和持续性肺动脉高压 (PPHN)。因此，婴儿出生后需要立即干预以支持过渡。所有健康新生儿都建议延迟脐带结扎 (DCC)，这可以改善早产儿和先天性心脏病婴儿的预后；然而，对于出生后需要立即干预的新生儿，DCC 可能不可行。最近的研究探索了在患有 CDH 的婴儿中使用完整脐带进行复苏，以确定其在婴儿中的可行性、安全性和疗效，结果令人鼓舞。在本报告中，我们讨论了在患有 CDH 的婴儿中进行完整脐带复苏的生理基础，并回顾了上述报告，以期确定 CDH 婴儿脐带结扎的最佳时机。
