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Right sided congenital diaphragmatic hernia: A rare neonatal emergency.

Parate LH, Geetha CR, Vig S - Saudi J Anaesth (2015 Apr-Jun)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, M.S. Ramaiah Medical Collage, Bengaluru, Karnataka, India.

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Presence of liver herniation is a predictive of poor outcome... It results in caval compression, reduced preload and impaired cardiac output... Ventilation was instituted by keeping peak inspiratory pressure (PIP) of 20 cm H2O, FiO2 of 0.6 and respiratory rate of 60/min... His ABG revealed pH-7.25, PCO2 -44 mmHg, PO2 -88 mmHg HCO3 -18 mEq/L and lactates-1.5 ummol/L... His preductual and postductal SpO2 differed by 5%... Baseline parameters of heart rate 144/min and BP-66/40 mmHg were noted... His preductal SpO2 was 95% and posductal saturation was 90%... Pressure controlled ventilation was started with PIP of 20 cm H2O, respiratory rate of 50/min with FiO2 of 0.7... A right subcostal incision was made... Liver and bowel loops were reduced [Figure 2]... It consists of limiting PIP <25 cm H2O, permissive hypercapnia (PaCO2 between 45 and 60 mmHg)... Many centers lack advanced neonatal care facilities affecting the prognosis... However, still conventional technique have shown good outcome.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray showing intestinal loops and liver herniation
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Figure 1: Chest X-ray showing intestinal loops and liver herniation

Mentions: A 4-day-old baby weighing 2.3 kg born by vaginal delivery at 36 weeks. He was diagnosed antenatally as a case of CDH. In view of respiratory distress he was intubated. Ventilation was instituted by keeping peak inspiratory pressure (PIP) of 20 cm H2O, FiO2 of 0.6 and respiratory rate of 60/min. Circulatory support was started in the form of dopamine infusion and intravenous fluid. His echo revealed moderate pulmonary hypertension. Chest X-ray showed multiple intestinal loops with liver herniation in right sided hemithorax and severe mediastinal shift in the left side [Figure 1]. His ABG revealed pH-7.25, PCO2 -44 mmHg, PO2 -88 mmHg HCO3 -18 mEq/L and lactates-1.5 ummol/L. His preductual and postductal SpO2 differed by 5%. Hb was 15 g% and the rest of the investigations were normal. After 3 days of stabilization child was posted for surgical repair of the hernia.


Right sided congenital diaphragmatic hernia: A rare neonatal emergency.

Parate LH, Geetha CR, Vig S - Saudi J Anaesth (2015 Apr-Jun)

Chest X-ray showing intestinal loops and liver herniation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374241&req=5

Figure 1: Chest X-ray showing intestinal loops and liver herniation
Mentions: A 4-day-old baby weighing 2.3 kg born by vaginal delivery at 36 weeks. He was diagnosed antenatally as a case of CDH. In view of respiratory distress he was intubated. Ventilation was instituted by keeping peak inspiratory pressure (PIP) of 20 cm H2O, FiO2 of 0.6 and respiratory rate of 60/min. Circulatory support was started in the form of dopamine infusion and intravenous fluid. His echo revealed moderate pulmonary hypertension. Chest X-ray showed multiple intestinal loops with liver herniation in right sided hemithorax and severe mediastinal shift in the left side [Figure 1]. His ABG revealed pH-7.25, PCO2 -44 mmHg, PO2 -88 mmHg HCO3 -18 mEq/L and lactates-1.5 ummol/L. His preductual and postductal SpO2 differed by 5%. Hb was 15 g% and the rest of the investigations were normal. After 3 days of stabilization child was posted for surgical repair of the hernia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, M.S. Ramaiah Medical Collage, Bengaluru, Karnataka, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Presence of liver herniation is a predictive of poor outcome... It results in caval compression, reduced preload and impaired cardiac output... Ventilation was instituted by keeping peak inspiratory pressure (PIP) of 20 cm H2O, FiO2 of 0.6 and respiratory rate of 60/min... His ABG revealed pH-7.25, PCO2 -44 mmHg, PO2 -88 mmHg HCO3 -18 mEq/L and lactates-1.5 ummol/L... His preductual and postductal SpO2 differed by 5%... Baseline parameters of heart rate 144/min and BP-66/40 mmHg were noted... His preductal SpO2 was 95% and posductal saturation was 90%... Pressure controlled ventilation was started with PIP of 20 cm H2O, respiratory rate of 50/min with FiO2 of 0.7... A right subcostal incision was made... Liver and bowel loops were reduced [Figure 2]... It consists of limiting PIP <25 cm H2O, permissive hypercapnia (PaCO2 between 45 and 60 mmHg)... Many centers lack advanced neonatal care facilities affecting the prognosis... However, still conventional technique have shown good outcome.

No MeSH data available.


Related in: MedlinePlus