Young paediatricians on the frontline: awareness of neonatal stabilization in congenital diaphragmatic hernia prior to surgical referral
Abstract
Background: In congenital diaphragmatic hernia (CDH), survival and morbidity hinge on meticulous cardiopulmonary stabilization during the minutes to hours after birth often led by young paediatricians. Core elements include no bag-mask ventilation, early endotracheal intubation, orogastric decompression, titrated oxygen to preductal saturation milestones, gentle ventilation with permissive hypercapnia, hemodynamic optimization for PPHN, transport readiness and deferral of surgical repair until physiologic stability. Objective: To evaluate young paediatricians’ knowledge and practices in early CDH stabilization, quantify guideline fidelity, identify gaps (including beliefs about early surgery) and determine educational/system factors associated with high performance.
Methods: Multi-centre cross-sectional survey of junior paediatricians across labour wards, EDs and NICUs. A validated 48-item tool generated a stabilization fidelity score (SFS, 0–20). Multivariable models assessed associations between training exposures and high SFS (≥16/20).
Results: Among 312 respondents (mean age 28.4 years; 62% female, 61% tertiary centres), recent NRP was 68%, NICU ≥6 months 54%, CDH simulation 41%. Mean SFS was 13.8±3.4, 29.5% achieved ≥16/20. Strengths: intubation priority (84%), OG decompression (79%), transport checklists (74%). Gaps: avoidance of bag-mask ventilation (58%), correct preductal SpO₂ targets (46%), permissive hypercapnia (39%), stepwise PPHN management (41%). Notably, 35%…
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