2026-06-23 | Predictors of challenging initial intubation and association with outcomes in congenital diaphragmatic hernia.
To assess for differences in congenital diaphragmatic hernia patient characteristics between those requiring single or multiple intubation attempts, and to determine the relationship between number of intubation attempts and time to intubation with outcomes. This was a retrospective cohort study of 205 infants with congenital diaphragmatic hernia born at Texas Children's Hospital. Patient demographics and severity numbers were compared to number of laryngoscopies as a surrogate for intubation attempts. Number of laryngoscopies and time to intubation were compared to clinical outcomes. Binary logistic regression and receiver operating characteristic curve analysis were used. There was no significant difference in baseline characteristics or CDH severity in those requiring single or multiple attempts. Greater number of intubation attempts was not associated with adverse outcomes but there was a significant association between longer time to successful intubation and mortality and higher risk of tracheostomy or death before discharge. Each additional minute before successful intubation was associated with 28% higher odds of mortality (p = 0.031) and 42% higher odds of tracheostomy or death before discharge (p = 0.006) CONCLUSION: Delayed time to intubation but not number of intubation attempts was associated with higher mortality and risk of tracheostomy or death in babies with CDH. Prenatal information including receipt of the FETO procedure, CDH severity markers, gestational age and birth weight cannot reliably be used to predict the likelihood of challenging intubations in infants with CDH.
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2026-06-19 | Bivalirudin use and Outcomes in Neonates With Congenital Diaphragmatic Hernia Managed With Extracorporeal Life Support.
To examine national trends in bivalirudin use among neonates with congenital diaphragmatic hernia (CDH) supported with extracorporeal membrane oxygenation (ECMO) and to evaluate its association with mortality and morbidity. Preliminary data suggest that first-line anticoagulation of the ECMO circuit with bivalirudin, a direct thrombin inhibitor, may improve outcomes in neonates with CDH. This multicenter retrospective cohort study used data from 48 United States children's hospitals from January 1, 2016, to December 31, 2023. The analytic cohort included neonates with CDH supported with ECMO. Patients were categorized by anticoagulant exposure: bivalirudin or unfractionated heparin. The primary outcome was in-hospital mortality. Secondary outcomes included anticoagulant utilization and anticoagulant-associated morbidity. Multivariable logistic regression models were constructed after exclusion of extreme high-volume center outliers. Among 1,049 neonates, bivalirudin use increased significantly over time, from 9.6% in 2016 to 48.0% in 2023. In the final cohort of 820 neonates, 398 died in hospital (48.5% mortality). Median hospital charges were higher among neonates receiving bivalirudin [$876,054 (IQR, $652,735 - $1,366,728)] compared with heparin [$577,326 (IQR, $384,468 - $871,769); P<0.0001]. Bivalirudin use was not associated with in-hospital mortality [adjusted odds ratio (aOR), 1.08, 95% CI, 0.42-2.82; P=0.87], bleeding (aOR, 1.43, 95% CI, 0.54-3.82; P=0.47), thrombosis (aOR, 1.88; 95% CI, 0.65-5.41; P=0.24), or neurologic complications (aOR, 2.00; 95% CI, 0.81-4.91; P=0.13). Among neonates with CDH supported with ECMO, bivalirudin use increased substantially over the study period and was associated with higher hospital charges but not with improved survival or reduced ECMO-related morbidity compared with unfractionated heparin.
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