Bedside Neonatal Intensive Care Unit Correction of Congenital Diaphragmatic Hernia: Is Repair without Compromise?

Abstract

Objectives This study aims to evaluate the feasibility, safety, limitations, and outcomes of performing different surgical approaches and techniques for the bedside repair of congenital diaphragmatic hernia (CDH) in critically ill patients who cannot be transferred to the operating room. Study Design Between December 1997 and July 2013, medical charts of all neonates operated on at the bedside for CDH while on high-frequency oscillatory ventilation (HFOV) and nitric oxide were reviewed. Demographic data; contributing antenatal, perinatal, and postnatal factors; clinical presentation; associated anomalies; respiratory and hemodynamic status; operative details; complications, and outcome were analyzed. Results A total of 101 cases of CDH were operated on, of which 11 were in very critical condition and operated on at the bedside in the neonatal intensive care unit (NICU). The mean gestational age was 38.09 weeks, birth weight, 2.91 kg, and age at surgery, 10 days. All were on HFOV and inotropic support and had pulmonary hypertension. Nine of them were on nitric oxide. Mean preoperative parameters were as follows: O2, 52%; mean airway pressure, 15; pH, 7.40; Po 2, 88.5 mm Hg; and Pco 2, 47 mm Hg. Nine patients underwent laparotomy and two underwent thoracoscopy. All procedures were completed uneventfully. Conclusions Bedside repair of CDH in the NICU while on HFOV is feasible and safe. It is not associated with any compromise in the surgical approach or technique.

Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery

“…Even if the number of procedures were not recorded, indications to bedside surgery were in line with those reported in the literature, and the bedside approach is adopted for several procedures in the NICUs surveyed including open abdominal surgery (necrotizing enterocolitis, intestinal perforation, abdominal wall defect repair/reduction, stoma creation), and thoracic surgery (congenital diaphragmatic hernia, tracheostomy, drainage), central line placement, cardiac surgery (ligation of patent ductus arteriosus) [ 1 , 2 , 9 , 16 – 21 ] Neonates in need of surgery are traditionally transferred to the main OR, outside the NICU. Most of them are premature with a low birth weight, cardiovascular instability and prolonged ventilator support.…”

Soft Tissue Repair with Easy-Accessible Autologous Newborn Placenta or Umbilical Cord Blood in Severe Malformations: A Primary Evaluation

“…Affected newborns without spare tissue are dependent of donor tissue. Because of the worldwide perinatal organ donor shortage [ 1 ], prosthetic materials are sometimes being used [ 5 , 6 ], which might be associated with complications such as recurrence, graft dislodgement and/or rejections, erosion of the graft, and infections [ 7 – 9 ]. Biological graft material would be preferable and consists of the extracellular compartment of human or animal tissue.…”