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Ann Thorac Surg 1982;33:174-178
© 1982 The Society of Thoracic Surgeons

Articles

The Management of Neonatal Posterolateral Diaphragmatic Hernia

James D. O'Callaghan, F.R.C.S., Nigel R. Saunders, F.R.C.S., Ranjit R. Chatrath, F.F.A.R.C.S., Duncan R. Walker, F.R.C.S.*

From the Regional Centre for Paediatric Cardiothoracic Surgery, Killingbeck Hospital, Leeds, Yorkshire, England

Accepted for publication March 9, 1981.

* Address reprint requests to Mr. Walker, Killingbeck Hospital, Leeds, Yorkshire, England LS14 6UK

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 µg/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 postoperatively, 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).




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S. F. Sawyer, K. W. Falterman, J. P. Goldsmith, and R. M. Arensman
Improving Survival in the Treatment of Congenital Diaphragmatic Hernia
Ann. Thorac. Surg., January 1, 1986; 41(1): 75 - 78.
[Abstract] [PDF]


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