The Canadian CDH Collaborative

This app provides a point-of-care resource for evidence-based and consensus-driven national guidelines for the health surveillance and care of patients with congenital diaphragmatic hernia (CDH). The guidelines cover all aspects of care beginning at prenatal diagnosis through to hospital discharge and post-discharge surveillance. The guidelines are intended for any stakeholder involved in the care of CDH patients, including but not limited to specialty and primary medical care providers, allied health professionals, and families. The app is organized into distinct sections that correspond to the phase of care. Each phase of care provides recommendations that indicate their level of evidence and the strength of expert consensus. Each recommendation is also accompanied by a brief description of the evidence behind the formulation of the recommendation as well as a list of supportive references. The ultimate goal for the dissemination of the guidelines is to improve the quality of health care delivery for CDH patients by providing optimal performance benchmarks and removing unwanted variations in care.

The app not only provides access to the guidelines, but also additional resources that may be beneficial to teams caring for CDH patients. They include (a) a link to the full, unabridged recommendations that provides more in-depth discussions of supporting evidence; (b) a daily intensive care rounding checklist designed specifically for CDH patients; (c) a guideline compliance tool that allows individual hospital centres to track their adherence to the guidelines as part of a continuous quality improvement initiative; and (d) two calculators that facilitate the calculation of the observed-expected lung-to-head ratio (o/e LHR) and the oxygenation index (OI).

The guidelines were created by the Canadian CDH Collaborative (CCC). The CCC is a representative group of specialists from across Canada with expertise in the fields of maternal-fetal medicine, pediatric surgery, pediatric anesthesia, neonatal intensive care, neonatal follow-up, pediatric intensive care, and pediatric cardiology. The steering committee of the CCC will update the recommendations every three years based on new evidence such that the guidelines are a “living document.” Financial support for the development of the app was provided by a grant from the Medical Services Staff Association Innovation Fund at Montreal Children’s Hospital.