The Annals of Thoracic Surgery, Vol 33, 174-178, Copyright © 1982 by The Society of Thoracic Surgeons
The management of neonatal posterolateral diaphragmatic hernia
JD O'Callaghan, NR Saunders, RR Chatrath and DR Walker
Between March, 1978, and August, 1980, 7 neonates with a left
posterolateral diaphragmatic hernia were seen in respiratory distress
within 12 hours of birth. Each had severe acidosis and hypoxia. They were
immediately intubated and ventilated. Arterial and central venous lines
were inserted, the acidosis was partially corrected, and a dopamine
infusion of 5 microgram/kg/min was begun immediately. Continuous monitoring
of arterial and venous pressures, core, and skin temperatures, blood gases,
and pH was instituted. Diaphragmatic defects were repaired by direct suture
in 5 neonates and by Gore-Tex patches in the other 2. The left lung in all
patients was hypoplastic. Ventilation and inotropic support were continued
for 4 to 5 days post-operatively, and close control of acid-base balance
was maintained. All the patients are doing well. We consider the key to
survival to be management of the dangerous combination of acidosis (by
enhancing peripheral and renal perfusion with dopamine) and hypoxia (by
prolonged assisted ventilation).
