Management of neonatal posterolateral diaphragmatic hernia.

Abstract

Accepted 21 January 1983 occasionally. Several authors have noted that neonates who survive operation often improve dramatically at first but subsequently deteriorate with increasing hypoxaemia and die.3 4 1 The initial improvement indicates that pulmonary hypoplasia is probably not the primary cause of death. An increase in pulmonary vascular resistance and shunting of blood away from the lungs through a persisting "fetal" circulation have been shown in these patients" and may be the mechanism leading to clinical deterioration with increasing hypoxaemia.Infants with a congenital diaphragmatic hernia requiring operation within 24 hours of birth are usually considerably hypoxic and acidotic at the time of diagnosis. Hypoxia and acidosis both cause pulmonary vasoconstriction'2-4 and thus favour the persistence of a fetal-type circulation with right-to-left shunting. It has been shown in adults'3 and in newborn calves'4 that if the hydrogen-ion concentration of the blood is maintained at near-normal values3 '5 hypoxia produces only minor changes in the pulmonary vasculature, whereas it causes appreciable pulmonary vasoconstriction in the presence of acidosis. This research suggests that a disastrous condition may be prevented if the acid-base balance is carefully controlled in affected infants.Hypoxia and acidosis also cause myocardial depression and peripheral vasoconstriction, which 254 on 11 May 2018 by guest. Protected by copyright.

Congenital Diaphragmatic Hernia: Risk Factors and Experience in Southwest Region of Saudi Arabia

“…We divided the patients into the mentioned 4 groups according to the time at which they became symptomatic and to mortality. About 30 different pre-and post-operative factors covering respiratory, radiological, and clinical data mentioned by different authors [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] were statistically studied using different methods like student T-test, liner regression analysis, and simple correlation. These include: pre-and post-operative (Aa) DO 2 , FIO 2 , PaCO 2 , VI, OI, pH, mechanical ventilation, age at operation, birth weight, hospitalization period, age at examination, lung expansion, surgical discharge, TPN, GIT feeding, maturity, inotropic drugs, associated anomalies, stomach position, pneumothorax, Apgar score, antenatal diagnosis, and polyhydramnios.…”

“…Early diagnosis, efficient resuscitation and maximum cardiopulmonary support can considerably reduce the mortality of patients with even large congenital diaphragmatic hernia defect [1] .…”

Evaluation of Amniotic Membrane as Adhesion Prophylaxis in a Novel Surgical Gastroschisis Model

“…Gore-Tex surgical membrane has been used experimentally and clinically to cover peritoneal defects [8], and was free of adhesions. In contrast to many other synthetic implants it proved to be inert and without major foreign body reaction.…”

“…Because only minor complications were reported the surgical procedures must be illustrated. For special purposes antibiotics were given prophylactically [8]. Nevertheless, in some cases the Gore-Tex patch had to be removed because of infection, while others [9] routinely removed the patch in a second-look operation.…”