Intestinal Perforation during the Stabilization Period in a Preterm Infant with Congenital Diaphragmatic Hernia

Background Delayed surgery after stabilization of infants with congenital diaphragmatic hernia (CDH) is an accepted strategy. However, the evidence favoring delayed versus immediate surgical repair is limited. We present an extremely rare case of a very low-birth-weight infant with prenatally diagnosed left-sided CDH and unexpected transmural bowel perforations developing within the postnatal stabilization period. Case Report A neonate born at 31st week of gestation with a birth weight of 1,470 g with antenatally diagnosed left-sided CDH presented with bowel dilation leading to transmural bowel perforations on the 2nd day of life. Meconium pleuroperitonitis resulted in severe systemic inflammatory response syndrome, pulmonary hypertension, multiple organ failure, and death. Conclusion In neonates with CDH deteriorating under standard postnatal management, intestinal perforation, and early surgical intervention should be considered.

Download Full-text

Mothers of Infants With Congenital Diaphragmatic Hernia Describe “Breastfeeding” in the Neonatal Intensive Care Unit: “As Long as It’s My Milk, I’m Happy”

Journal of Human Lactation ◽

10.1177/0890334417709469 ◽

2017 ◽

Vol 33 (3) ◽

pp. 524-532 ◽

Cited By ~ 3

Author(s):

Elizabeth B. Froh ◽

Janet A. Deatrick ◽

Martha A. Q. Curley ◽

Diane L. Spatz

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Neonatal Intensive Care Unit ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Neonatal Intensive Care ◽

Safety Net ◽

Prospective Longitudinal

Background: Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births. Currently, there are no studies examining the health outcomes of infants with CDH and the effect of human milk. Research aim: This study aimed to describe the breastfeeding experience of mothers of infants with CDH cared for in the NICU. Methods: A prospective, longitudinal qualitative descriptive design was used. Phased interviews were conducted with a purposive sample of 11 CDH infant–mother dyads from a level 3 NICU in a children’s hospital. Results: Six themes emerged from the data: (a) hopeful for breastfeeding, (b) latching on . . . to the pump, (c) we’ve already worked so hard, (d) getting the hang of it—it’s getting easier, (e) a good safety net, and (f) finding a way that works for us. Conclusion: For this population of CDH infant–mother dyads, the term breastfeeding is not exclusive to direct feeding at the breast and the mothers emphasized the significance of providing their own mother’s milk through a combination of feeding mechanisms to their infants with CDH.

Download Full-text

Effects of surgical repair on respiratory mechanics in congenital diaphragmatic hernia

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(88)80463-9 ◽

1988 ◽

Vol 23 (5) ◽

pp. 493

Author(s):

George Holcomb

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Respiratory Mechanics ◽

Surgical Repair

Download Full-text

CONGENITAL DIAPHRAGMATIC HERNIA: SURVIVAL TREATED WITH VERY DELAYED SURGERY, SPONTANEOUS RESPIRATION, AND NO CHEST TUBE

PEDIATRICS ◽

10.1542/peds.97.6.810 ◽

1996 ◽

Vol 97 (6) ◽

pp. 810-810

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Retrospective Review ◽

Chest Tube ◽

Surgical Repair ◽

Spontaneous Respiration ◽

Respiratory Care ◽

Delayed Surgery ◽

Membrane Oxygenation

This report suggests that stabilization of the intrauterine to extrauterine transitional circulation, combined with a respiratory care strategy that avoids pulmonary overdistension, takes advantage of inherent biological cardiorespiratory mechanics, and very delayed surgery for congenital diaphragmatic hernia results in improved survival and decreases the need for extracorporeal membrane oxygenation (ECMO). This retrospective review of a 10-year experience in which the respiratory care strategy, ECMO availability, and technique of surgical repair remained essentially contant describes the evolution of this method of management of congenital diaphragmatic hernia.

Download Full-text

A Single-Center Experience with Very Low Birth Weight Infants and Focal Intestinal Perforation: Comparison of Primary Anastomosis versus Stoma Opening

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1605348 ◽

2017 ◽

Vol 28 (05) ◽

pp. 426-432

Author(s):

Dario Consonni ◽

Francesco Macchini ◽

Giovanni Parente ◽

Andrea Zanini ◽

Stefania Franzini ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Intestinal Perforation ◽

Very Low Birth Weight ◽

Primary Anastomosis ◽

P Value ◽

Single Center ◽

Vlbw Infants ◽

Single Center Experience ◽

Focal Intestinal Perforation

Introduction We present a single-center experience with very low birth weight (VLBW) infants with focal intestinal perforation (FIP), comparing the results of primary anastomosis (PA) and stoma opening (SO). Materials and Methods Clinical records of VLBW infants with FIP who underwent surgery between 2006 and 2015 were reviewed. Patients were divided into two groups according to the procedure performed: limited bowel resection and PA or SO. Patients with gastric perforation or patients who underwent clip and drop were excluded. Information regarding birth weight (BW), gestational age (GA), weight at surgery (WS), number of abdominal reoperations, duration of parenteral nutrition (PN), and demise was recorded. Results In this study, 40 patients were included: 22 in PA group and 18 in SO group. BW was 865 g in PA and 778 in SO (p-value: 0.2). GA was 26.1 weeks in PA and 25.6 in SO (p-value: 0.3). WS was 1,014 g in PA and 842 in SO (p-value: 0.09). Duration of surgery was 115 minutes in PA and 122 in SO (p-value: 0.67). Five patients (23%) belonging to PA group developed complications and required SO. Five patients (23%) demised in PA group and six (33%) in SO (p-value: 0.2). Seventeen abdominal reoperations were performed in PA group and 22 in SO group (p-value: 0.08). Conclusion Both procedures appear to be safe. When possible, PA should be performed as it reduces the number of abdominal reinterventions.

Download Full-text