How can ventilators help babies with CDH?

Because babies with congenital diaphragmatic hernia (CDH) have underdeveloped,or hypoplastic, lungs, they often are unable to breathe at birth. Moreover, the lackof adequate blood vessels in hypoplastic lung tissue results in inadequate blood flow,causing high blood pressure in the lungs—a dangerous condition called pulmonaryhypertension. Because of these critical problems, many newborns with CDH requirehelp breathing from a ventilator.

Ventilators have traditionally been able to sustain about half of babies longenough to undergo and recover from surgery to repair their hernias, and eventually todevelop adequate lung tissue and breathe independently. Those administering theventilation have strived to achieve normal blood levels of oxygen and carbon dioxideby forcing the correct pressure into these tiny babies' lungs. But the application of toomuch pressure can damage undeveloped lungs, leading to sometimes serious, evenfatal, chronic lung disease.

Now, a technique called "kinder and gentler ventilation" has proven superior to thetraditional approach. Developed by Jen-TienWung, MD, Director, Neonatal RespiratoryCare, gentle ventilation seeks to apply the minimum level of respiratory support needed,rather than to achieve normal blood levels of oxygen. Dr.Wung began using lowerventilation pressures in babies with CDH after he observed that lower pressures significantlyimproved survival among babies who aspirated meconium.

Today, the survival rate for babies who receive ventilator support at the MorganStanley Childrens Hospital Neonatal Intensive Care Unit is almost 90%, compared tothe national average of 50-60%.

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