Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep;45(9):1247-1254.
doi: 10.1038/s41372-025-02226-z. Epub 2025 Feb 21.

Golden hour management of infants with congenital diaphragmatic hernia: 15 year experience at a high-volume center

K Taylor Wild  1   2 , Holly L Hedrick  3   4 , Natalie E Rintoul  5   3 , Anne M Ades  5   3 , Juliana S Gebb  3 , Leny Mathew  3 , Tom Reynolds  3 , Anna Bostwick  3 , Elizabeth Eppley  3 , Sabrina Flohr  3 , N Scott Adzick  3   4 , Elizabeth E Foglia  5   3
Affiliations

Golden hour management of infants with congenital diaphragmatic hernia: 15 year experience at a high-volume center

K Taylor Wild et al. J Perinatol. 2025 Sep.

Abstract

Objective: To review the evolution of golden hour management and outcomes for infants with congenital diaphragmatic hernia (CDH).

Study design: Retrospective single center cohort study of infants with CDH born 2008-2023 at a quaternary children's hospital. Infants were grouped into 3 epochs: 2008-2013, 2014-2018, and 2019-2023. Outcome measures included extracorporeal membrane oxygenation therapy and survival.

Result: There were 454 infants, including 106 (2008-2013), 156 (2014-2018), and 192 (2019-2023). Despite increased disease severity, survival improved over time, from 71% (2008-2013) to 82% (2014-2018) and 83% (2019-2023), p = 0.02 for trend, with no difference in ECMO utilization.

Conclusion: Management of infants with CDH continues to evolve with ongoing experience at our high-volume center. Despite increasing severity of illness, survival outcomes have improved over time. In the absence of clinical trial data, observational data should be evaluated rigorously to inform care in a data-driven manner.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have indicated they have no potential conflicts of interest relevant to this article to disclose. Ethics approval: This study was approved by the Institutional Review Board at the Children’s Hospital of Philadelphia (IRB 21-018553) and was performed in accordance with the Declaration of Helsinki. Consent to participate: The CHOP Institutional Review Board approved this observational study with a waiver of informed parental consent.

Figures

Fig. 1
Fig. 1. Timeline of changes in delivery room practice.
DR delivery room, ETTs endotracheal tubes, FETO fetoscopic endoluminal tracheal occlusion, HFOV high frequency oscillatory ventilation, iNO inhaled nitric oxide, SDU Special Delivery Unit, QI quality improvement.
Fig. 2
Fig. 2. Severity-specific delivery room algorithm for the delivery room resuscitation of infants with CDH.
ECG electrocardiogram, FiO2 Fraction of inspired oxygen, NIRS near infrared spectroscopy. *Mild to Moderate CDH = intrabdominal liver, Severe CDH = Intrathoracic liver or right CDH.
Fig. 3
Fig. 3. Survival, ECMO utilization, CDH repair, and length of stay compared across epochs.
Survival (A), ECMO utilization (B), CDH repair (C) and length of stay (D). Survival improved significantly over time (A), from 71% (2008–2013) to 82% (2014–2018) and 83% (2019–2023), p = 0.02 for trend. There was no difference in ECMO utilization over time (B) but there was a significant increase in CDH repair (C), p < 0.001.
See this image and copyright information in PMC

References

    1. Wild KT, Rintoul N, Hedrick HL, Heimall L, Soorikian L, Foglia EE, et al. Delivery room resuscitation of infants with congenital diaphragmatic hernia: lessons learned through video review. Fetal Diagn Ther. 2024:1–9. 10.1159/000538536. - PubMed
    1. Schultz CM, Digeronimo RJ, Yoder BA. Congenital diaphragmatic hernia: a simplified postnatal predictor of outcome. J Pediatr Surg. 2007;42:510–6. 10.1016/j.jpedsurg.2006.10.043. - PubMed
    1. Salas AA, Bhat R, Dabrowska K, Leadford A, Anderson S, Harmon CM, et al. The value of Pa(CO2) in relation to outcome in congenital diaphragmatic hernia. Am J Perinatol. 2014;31:939–46. 10.1055/s-0034-1368088. - PubMed
    1. Khmour AY, Konduri GG, Sato TT, Uhing MR, Basir MA. Role of admission gas exchange measurement in predicting congenital diaphragmatic hernia survival in the era of gentle ventilation. J Pediatr Surg. 2014;49:1197–201. 10.1016/j.jpedsurg.2014.03.011. - PubMed
    1. Abbas PI, Cass DL, Olutoye OO, Zamora IJ, Akinkuoto AC, Sheikh F, et al. Persistent hypercarbia after resuscitation is associated with increased mortality in congenital diaphragmatic hernia patients. J Pediatr Surg. 2015;50:739–43. 10.1016/j.jpedsurg.2015.02.028. - PubMed

MeSH terms

LinkOut - more resources