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CC BY-NC-ND 4.0 · Journal of Fetal Medicine
DOI: 10.1055/s-0044-1786166
Case Report

Ultrasound Differentiation of Twins with Discordant Congenital Diaphragmatic Hernia in the Delivery Room

Sean Michael Cullen 
1   Department of Pediatrics, Division of Neonatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Ericalyn Kasdorf
1   Department of Pediatrics, Division of Neonatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Sara Cohen
2   Department of Radiology, Division of Pediatric Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Arzu Kovanlikaya
2   Department of Radiology, Division of Pediatric Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Brittany Roser
3   Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Corrina Oxford-Horrey
3   Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Cynthia Perez
1   Department of Pediatrics, Division of Neonatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Catherine Chang
4   Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, Utah, United States
› Author Affiliations Funding None.
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Abstract

Most infants with prenatally diagnosed congenital diaphragmatic hernia (CDH) are intubated rapidly after birth to optimize oxygenation and ventilation while avoiding abdominal distention and high mean airway pressures. A twin pregnancy complicated by one twin with a CDH diagnosis is a rare event and is associated with preterm delivery and low birth weight compared to singletons with CDH. In rare cases of discordant CDH in twin pregnancies with an absence of external distinguishing features (similar weights, fetal presentation, and sex), it may be difficult to quickly determine which twin has CDH in the delivery room (DR), raising ambiguity about the best management of both infants. This case describes the successful use of ultrasound (US) in the DR to rapidly diagnose the presence or absence of CDH in discordant twins. By developing a resuscitation algorithm and using in situ simulations prior to delivery, the twin with CDH was rapidly identified, intubated, and transported to the neonatal intensive care unit (NICU) for further management. The twin without CDH received routine care and was transferred to the well-baby nursery. Interprofessional planning and simulation may be used to design a safe resuscitation plan incorporating US diagnosis of diaphragmatic anomalies into the Neonatal Resuscitation Program (NRP) algorithm.

Keywords

congenital diaphragmatic hernia - ultrasound - simulation - delivery room - twin gestation

Author Contributions

S.M.C wrote the first draft of the manuscript with specific contributions from B.R. and S.H.S.M.C, E.K., C.P., C.C., S.C., A.K., B.R., and C.O.-H. contributed to the conception and design of the study, critical revision of the manuscript for important intellectual input, gave final approval of the manuscript, and agree to be accountable for all aspects of the work.


Study Approval Statement

This study protocol was reviewed and approved by Weill Cornell Medicine Institutional Review Board (approval number: 21-12024204).


Patients' Consent

The parents of these children provided written informed consent for publication of this case report and use of the images therein.




Publication History

Article published online:
19 April 2024

© 2024. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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