Neonatal intensive care unit on‑site surgery for congenital diaphragmatic hernia

Abstract

The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of ‘Maria S. Curie’ Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

“…Higher Post-operative VIS and RSS scores were predictive of mortality in our cohort. This is consistent with previous studies reporting on the use of RSS as a predictor of mortality [32] and higher post-op VIS scores being predictive of negative outcomes in infants with CDH [51]. VIS more than 23 was associated with high mortality in our cohort.…”

Current management of surgical neonates: is it optimal or do we need to improve? A national survey of the Italian Society of Neonatology

“…These procedures align with the current criteria for BS. Thoracic surgery for congenital diaphragmatic hernia repairs or congenital pulmonary airway malformation corrections is performed at the patient’s bedside in 40.0% of Italian centers where BS is practiced; this is in agreement with the increasing reports about this kind of surgery performed at patients’ bedside [ 26 – 28 ].…”

Successful management of Congenital Diaphragmatic Hernia (CDH) in an 8-day-old infant with moderate persistent pulmonary hypertension, moderate muscular Ventricular Septal Defect (VSD), and small Patent Ductus Arteriosus (PDA)

“…10 Rather than emergency surgical repair in the early neonatal phase, stabilization of the vital function is more crucial. 18, 19 Unstable respiratory function increases the mortality rate during surgery, while stable vital functions may delay the surgery up to 7-10 days. 20 A consensus stated that an open surgical procedure is preferable for the minimally invasive (MIS) approach.…”