Use of sildenafil in late postoperative period of congenital diaphragmatic hernia

Background. The study aims to verify if the time of preoperative stabilization (≤24 or >24 hours) could be predictive for the severity of clinical condition among patients affected by congenital diaphragmatic hernia.Methods. 55 of the 73 patients enrolled in the study achieved presurgical stabilization and underwent surgical correction. Respiratory and hemodynamic indexes, postnatal scores, the need for advanced respiratory support, the length of HFOV, tracheal intubation, PICU, and hospital stay were compared between patients reaching stabilization in ≤24 or >24 hours.Results. Both groups had a 100% survival rate. Neonates stabilized in ≤24 hours are more regular in the postoperative period and had an easier intensive care path; those taking >24 hours showed more complications and their care path was longer and more complex.Conclusions. The length of preoperative stabilization does not affect mortality, but is a valid parameter to identify difficulties in survivors’ clinical pathway.

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Predicting Full Enteral Feeding in the Postoperative Period in Infants with Congenital Diaphragmatic Hernia

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1597655 ◽

2017 ◽

Vol 27 (05) ◽

pp. 431-436 ◽

Cited By ~ 11

Author(s):

Miryam Triana ◽

Rosario Madero ◽

Steven Abrams ◽

Leopoldo Martinez ◽

Maria Amesty ◽

...

Keyword(s):

Gastroesophageal Reflux ◽

Congenital Diaphragmatic Hernia ◽

Hospital Discharge ◽

Diaphragmatic Hernia ◽

Enteral Feeding ◽

Postoperative Period ◽

Surgical Repair ◽

Factors Associated ◽

Enteral Feedings ◽

Full Enteral Feeding

Introduction The objective of the study is to examine the factors associated with time to achieve full enteral feeding after repair of congenital diaphragmatic hernia. Materials and Methods Demographic, clinical, and therapeutic data were retrospectively assessed, and uni- and multivariate Cox regression were performed to examine factors predictive of achieving full enteral feeding that was defined as time to achieve120 mL/kg/d after surgical repair. Results Of 78 infants, 66 underwent intervention before hospital discharge. All infants who survived had reached full enteral feeding at the time of hospital discharge by a median of 22 days (range: 2–119 days) after surgery and 10 days (range: 1–91) after initiation of postoperative enteral feedings. Independent risk factors associated with a longer time to reach full enteral feeding achievement included gastroesophageal reflux and days of antibiotics in the postoperative period. Daily stool passage preoperatively predicted earlier enteral tolerance. Conclusion Infants who survive congenital diaphragmatic hernia generally are able to achieve full enteral feedings after surgical repair. A longer time to full feeding is needed in the most severe cases, but some specific characteristics can be used to help identify patients at higher risk. Although some of these characteristics are unavoidable, others including rational antibiotic usage and active gastroesophageal reflux prevention and treatment are feasible and may improve enteral tolerance.

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