Acute gastrointestinal compromise in neonates with congenital diaphragmatic hernia prior to repair.

Abstract:

BACKGROUND:Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise. METHODS:A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012). RESULTS:A total of 126 CDH patients were managed during the 8-year period. Five neonates (male - 1; gestation 37+4-39+7; birth weight 2.9-3.7kg; left CDH - 5) required emergency operative intervention for presumed gastrointestinal compromise. All five neonates demonstrated systemic hypotension despite inotropic support, raised serum lactate (>2mmol/L), and abnormal radiographic findings. Operative intervention occurred within 3days of birth (1-3days). Findings included gastric volvulus, jejunal volvulus, and perforated caecum. All patients underwent primary diaphragmatic repair without a patch. Temporary ileostomy was required in 1 patient. All patients remain alive. CONCLUSION:Gastrointestinal compromise is a rare, but potentially catastrophic, complication of CDH. Emergency operative intervention may be required in a select cohort of patients. Early deterioration following birth should alert clinicians to the possibility of significant intestinal pathology. LEVEL OF EVIDENCE:Level IV case series with no comparison group.

journal_name

J Pediatr Surg

authors

Fox C,Stewart M,King SK,Patel N

doi

10.1016/j.jpedsurg.2016.09.012

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

1917-1920

issue

12

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(16)30335-9

journal_volume

51

pub_type

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