Our Summary

The research paper describes a study on babies born with a condition called Congenital Diaphragmatic Hernia (CDH), which affects about 1 in 3000 live births. In this condition, a baby’s diaphragm, the muscle that separates the chest from the abdomen, doesn’t form properly. This can cause some of the baby’s organs to move into the chest, which can lead to problems with heart and lung development.

Usually, doctors wait to repair the diaphragm to improve the baby’s heart and lung function before surgery. However, in this study, the researchers looked at a group of babies who needed emergency surgery soon after birth because their intestines were in danger.

The study looked at 126 babies with CDH over an 8-year period. Five of these babies needed emergency surgery because their intestines were at risk. Despite medical support, these babies had low blood pressure, high levels of lactic acid in their blood (which can indicate that the body is not getting enough oxygen), and unusual findings on X-rays. These babies had surgery within 3 days of birth and were found to have serious problems with their stomach or intestines.

All five babies survived the surgery and are still alive. The researchers conclude that while this type of emergency is rare in babies with CDH, doctors should be aware that it can happen, and should watch for signs of serious intestinal problems in these babies.

FAQs

  1. What is the prevalence of congenital diaphragmatic hernia (CDH) in live births?
  2. What are some complications that may require early emergency operative intervention in neonates with CDH?
  3. What are the signs that may alert clinicians to the possibility of significant intestinal pathology in neonates with CDH?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to be aware of the signs of potential gastrointestinal compromise, such as systemic hypotension, raised serum lactate levels, and abnormal radiographic findings. If these symptoms occur, early intervention may be necessary to prevent potentially catastrophic complications. It is important to seek medical attention promptly if any concerning symptoms arise.

Suitable For

Patients who are typically recommended congenital diaphragmatic hernia repair are neonates with CDH who demonstrate systemic hypotension despite inotropic support, raised serum lactate levels, and abnormal radiographic findings indicating gastrointestinal compromise. In some cases, emergency operative intervention may be required to address potentially fatal intestinal pathology such as gastric volvulus, jejunal volvulus, or perforated caecum. Early deterioration following birth should alert clinicians to the possibility of significant intestinal issues, and prompt intervention may be necessary to ensure the best possible outcome for these patients.

Timeline

  • Before congenital diaphragmatic hernia repair:

  • The patient is diagnosed with congenital diaphragmatic hernia, typically through prenatal ultrasound or shortly after birth.

  • The patient may experience respiratory distress, feeding difficulties, and other symptoms related to the hernia.

  • The patient undergoes pre-operative optimization of cardiorespiratory status to prepare for surgery.

  • After congenital diaphragmatic hernia repair:

  • In cases where emergency operative intervention is required, the patient undergoes surgery within a few days of birth.

  • The surgical procedure involves repairing the diaphragm and addressing any gastrointestinal complications such as gastric volvulus, jejunal volvulus, or perforated caecum.

  • Temporary ileostomy may be required in some cases.

  • The patient is monitored closely post-operatively for any complications and receives appropriate medical care to support recovery.

  • With proper management, the patient can survive and potentially thrive after congenital diaphragmatic hernia repair.

What to Ask Your Doctor

  1. What are the potential complications of congenital diaphragmatic hernia repair?
  2. How will the repair surgery be performed?
  3. What is the expected recovery time following surgery?
  4. Will there be any long-term effects or restrictions after the repair?
  5. How often should follow-up appointments be scheduled after the surgery?
  6. What signs or symptoms should I watch for that may indicate a complication after surgery?
  7. Will there be any dietary restrictions or special care instructions following surgery?
  8. What is the success rate of this type of surgery for congenital diaphragmatic hernia?
  9. Are there any alternative treatment options or additional therapies that may be recommended?
  10. Are there any genetic factors or family history that may increase the risk of congenital diaphragmatic hernia in future pregnancies?

Reference

Authors: Fox C, Stewart M, King SK, Patel N. Journal: J Pediatr Surg. 2016 Dec;51(12):1917-1920. doi: 10.1016/j.jpedsurg.2016.09.012. Epub 2016 Sep 15. PMID: 27712890