Anaesthetic Management of a Neonate with Congenital Diaphragmatic Hernia
Date Issued
2022-12
Author(s)
Tijana Nastasovic
Abstract
Abstract: Introduction: Congenital diaphragmatic hernia (CDH) is an anatomical structural defect that
allows passage of the abdominal viscera into the chest cavity. A Bochdalek hernia is a defect in the
posterior left side of the diaphragm. Between 80 and 90 % of congenital diaphragmatic hernias are of
this type. Objectives: An anesthetic, respiratory, and perioperative management of a neonate with CDH
and patent ductus arteriosus (PDA) is presented. Case report: In this case presentation of a two-day old
male neonate who was born preterm at 35 gestational weeks due to maternal asphyxia, intubation was
performed and mechanical ventilation was started, inotropic and vasopressor support as well due to
hemodynamic instability. After appropriate diagnostic procedures, CDH is confirmed, with herniation
of the stomach: spleen, left, liver lob in the thoracic cavity, and left lung hypoplasia. The neonate is
taken to the operating room for diaphragmatic defect repair surgery. After correction of the defect,
closure was started. Due to increased IAP, hemodynamic instability with low arterial blood pressure and
pulmonary hypertension reversed the shunt through PDA from left to right, and the baby deteriorated.
Immediate resuscitation with adrenalin and phenylephrine was started. The surgical wound was opened
and temporary closure technique by negative pressure with vacuum-assisted closure therapy (VAC) was
placed, after which the baby stabilized. Conclusion : The management of CDH in neonates who also
have PDA is a multidisciplinary and major challenge. The severity of pulmonary hypoplasia, pulmonary
hypertension, persistent fetal circulation (PFC), associated malformations, and iatrogenic lung injury
associated with aggressive mechanical ventilation are major factors, which contribute to the mortality
and morbidity in babies with CDH. The perioperative management of pulmonary hypertension, lung
hypoplasia, and physiologic stabilization by a highly skilled anesthesia team also plays an important
role in the final therapeutic outcome. Despite advances in anesthetic and surgical management, the
survival rate of CDH infants remains 60-70%.
allows passage of the abdominal viscera into the chest cavity. A Bochdalek hernia is a defect in the
posterior left side of the diaphragm. Between 80 and 90 % of congenital diaphragmatic hernias are of
this type. Objectives: An anesthetic, respiratory, and perioperative management of a neonate with CDH
and patent ductus arteriosus (PDA) is presented. Case report: In this case presentation of a two-day old
male neonate who was born preterm at 35 gestational weeks due to maternal asphyxia, intubation was
performed and mechanical ventilation was started, inotropic and vasopressor support as well due to
hemodynamic instability. After appropriate diagnostic procedures, CDH is confirmed, with herniation
of the stomach: spleen, left, liver lob in the thoracic cavity, and left lung hypoplasia. The neonate is
taken to the operating room for diaphragmatic defect repair surgery. After correction of the defect,
closure was started. Due to increased IAP, hemodynamic instability with low arterial blood pressure and
pulmonary hypertension reversed the shunt through PDA from left to right, and the baby deteriorated.
Immediate resuscitation with adrenalin and phenylephrine was started. The surgical wound was opened
and temporary closure technique by negative pressure with vacuum-assisted closure therapy (VAC) was
placed, after which the baby stabilized. Conclusion : The management of CDH in neonates who also
have PDA is a multidisciplinary and major challenge. The severity of pulmonary hypoplasia, pulmonary
hypertension, persistent fetal circulation (PFC), associated malformations, and iatrogenic lung injury
associated with aggressive mechanical ventilation are major factors, which contribute to the mortality
and morbidity in babies with CDH. The perioperative management of pulmonary hypertension, lung
hypoplasia, and physiologic stabilization by a highly skilled anesthesia team also plays an important
role in the final therapeutic outcome. Despite advances in anesthetic and surgical management, the
survival rate of CDH infants remains 60-70%.
File(s)![Thumbnail Image]()
Loading...
Name
TRUD UTSAK KONGRES diphragmatic hernia Gavriloska 24 25 DECEMBER 2022 ANKARA TURKEY.pdf
Size
4.63 MB
Format
Adobe PDF
Checksum
(MD5):9056b1820e07dd8eabf01ca7b37e05af