Young paediatricians on the frontline: awareness of neonatal stabilization in congenital diaphragmatic hernia prior to surgical referral

Saima Ghafoor; Khowla Rabbani; Maryam Ghaffar; Shabana Tehreem; Waqas Ali; Fahad Iqbal; Muhammad Zaeem Khalid

doi:10.18203/2320-6012.ijrms20260223

Authors

Saima Ghafoor Shalamar Hospital, Lahore, Pakistan
Khowla Rabbani Shaikh Zayed Hospital, Lahore, Pakistan
Maryam Ghaffar Shalamar Hospital, Lahore, Pakistan
Shabana Tehreem Shalamar Hospital, Lahore, Pakistan
Waqas Ali Shalamar Hospital, Lahore, Pakistan
Fahad Iqbal Shalamar Hospital, Lahore, Pakistan
Muhammad Zaeem Khalid Shaikh Zayed Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260223

Keywords:

Timing of surgery, Persistent pulmonary hypertension of the new born (PPHN), Gentle ventilation, Congenital diaphragmatic hernia, Neonatal stabilization

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% believed earlier repair helps even when unstable; 18% were unsure. NRP, NICU time, simulation and unit checklists independently increased odds of high SFS.

Conclusions: Young paediatricians execute procedures well but often miss numeric targets and algorithmic PPHN therapy; misconceptions about early surgery persist. Low-cost levers checklists, simulation that drills the numbers, NRP reinforcement and explicit myth-busting (“stabilize first, repair later”) can raise fidelity and pre-operative readiness.

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