Congenital Diaphragmatic Hernia: Experience with Preoperative Stabilization and Delayed Surgery without ECMO and Inhaled Nitric Oxide
| Autor: | Gasudraz S. Ahmed, Stanley Crankson, Muneef M. Al-Hathal, Khalil Al Tawil, Fahad Al-Harbi |
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| Rok vydání: | 1998 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Nitric Oxide Medical Records Pulmonary hypoplasia Extracorporeal Membrane Oxygenation Intensive care Respiratory muscle medicine Extracorporeal membrane oxygenation Humans Hernia Retrospective Studies Hernia Diaphragmatic Respiratory Distress Syndrome Newborn Respiratory distress business.industry Infant Newborn Obstetrics and Gynecology Congenital diaphragmatic hernia medicine.disease Survival Analysis Pulmonary hypertension Bronchodilator Agents Surgery Treatment Outcome Anesthesia Pediatrics Perinatology and Child Health Female Hernias Diaphragmatic Congenital business |
| Zdroj: | American Journal of Perinatology. 15:487-490 |
| ISSN: | 1098-8785 0735-1631 |
| DOI: | 10.1055/s-2007-994070 |
| Popis: | Despite many advances in the management of congenital diaphragmatic hernia (CDH), the condition carries a mortality rate of 40-50% usually consequent to pulmonary hypoplasia and/or persistent pulmonary hypertension. Several centers have reported improved survival with preoperative stabilization and delayed surgery, which is now an accepted method of management. This is a retrospective analysis of all neonates with respiratory distress at birth due to CDH who were treated at our institution with neither extracorporeal membrane oxygenation nor nitric oxide being used. The medical records of all neonates with CDH and respiratory distress at birth who were treated at this institution from August 1, 1992 through March 1, 1997 were reviewed. There were 21 patients, 11 male and 10 female. There were 17 full-term and 4 premature infants; two premature infants at 30 and 34 weeks' gestation were not resuscitated because of severe associated congenital anomalies. Surgery was performed from 5 to 144 hr (mean 45 hr) in 18 infants. One infant died during preoperative stabilization from severe pulmonary hypoplasia and pulmonary hypertension and one infant died postoperatively from the same conditions. Seventeen of 19 infants (89.5%) survived and were discharged home. Three infants (17.6%) who failed to thrive due to severe gastroesophageal reflux (GER) required fundoplication. Eleven infants (64.7%) who had sepsis proven by blood culture responded satisfactorily to appropriate antibiotics. Preoperative stabilization and delayed surgery has been a satisfactory form of management in our series. The significant complication was sepsis, which must be addressed. |
| Databáze: | OpenAIRE |
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