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DIAPHRAGMATIC HERNIA

Malik Mahmood Alam

Abstract


This three hours old girl was transferred to Valley Hospital from another Private Hospital. She was born full term by C-section due to poor progress in 2nd stag. She had low Apgars at birth and needed bagging and then intubation. She was also given intravenous antibiotics and steroids. She was immediately shifted to the Valley Hospital by intermittent positive pressure ventilation through endotracheal tube.

On arrival she was blue and had saturations of 25% with heart rate of 130/min. Her tube was dislodged during transfer and therefore she was briefly bagged and intubated with size 3.5 tube.

Her saturations went up to 80% but no air entry was heard on left side. Immediate x-ray was taken and it showed diaphragmatic hernia on left side and extending up to right side as well.

Congenital Diaphragmatic hernia is seen in 1 of every 2000–4000 live births. 84% of these occur on left side 13% on right side and 2% are bilateral.1

Most of the congenital hernias are detected on antenatal ultrasound scans2 or soon after birth due to difficulty in breathing. Mortality is due to pulmonary hypoplasia.       

Fetal MRI may be performed to detect diaphragmatic hernia.3,4 Postnatally Chest x-ray will show the intestines in the chest with lung hypoplasia.

Delivery of the babies should be in the tertiary unit with facilities for neonatal surgeries and ECMO.5


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References


Gucciardo L, Deprest J, Done' E, Van Mieghem T, Van de Velde M, Gratacos E, et al. Prediction of outcome in isolated congenital diaphragmatic hernia and its consequences for fetal therapy. Best Pract Res Clin Obstet Gynaecol 2008;22(1):123–38.

Chinn DH, Filly RA, Callen PW, Nakayama DK, Harrison MR. Congenital diaphragmatic hernia diagnosed prenatally by ultrasound. Radiology 1983;148(1):119–23.

Mehollin-Ray AR, Cassady CI, Cass DL, Olutoye OO. Fetal MR imaging of congenital diaphragmatic hernia. Radiographics 2012;32(4):1067–84.

Victoria T, Danzer E, Adzick NS. Use of ultrasound and MRI for evaluation of lung volumes in fetuses with isolated left congenital diaphragmatic hernia. Semin Pediatr Surg 2013;22(1):30–6.

Le LD, Keswani SG, Biesiada J, Lim FY, Kingma PS, Haberman BE, et al. The congenital diaphragmatic hernia composite prognostic index correlates with survival in left-sided congenital diaphragmatic hernia. J Pediatr Surg 2012;47(1):57–62.


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