Document Detail


Congenital diaphragmatic hernia: experience with preoperative stabilization and delayed surgery without ECMO and inhaled nitric oxide.
MedLine Citation:
PMID:  9788647     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
M Al-Hathal; S J Crankson; F Al-Harbi; G Ahmed; K Tawil
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of perinatology     Volume:  15     ISSN:  0735-1631     ISO Abbreviation:  Am J Perinatol     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-12-29     Completed Date:  1998-12-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8405212     Medline TA:  Am J Perinatol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  487-90     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
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MeSH Terms
Descriptor/Qualifier:
Bronchodilator Agents / therapeutic use
Extracorporeal Membrane Oxygenation
Female
Hernia, Diaphragmatic / complications,  congenital*,  surgery*
Humans
Infant, Newborn
Male
Medical Records
Nitric Oxide / therapeutic use
Respiratory Distress Syndrome, Newborn / etiology,  therapy*
Retrospective Studies
Survival Analysis
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bronchodilator Agents; 10102-43-9/Nitric Oxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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