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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

PAH clearance was carried out in 12 newborns, hospitalized in the infantile resuscitation unit for respiratory distress. 6 of these children weighed less than 2.5 kg, 4 had hyaline membrane disease, 6 had either amniotic abnormalities or transitory tachypnea, 2 were surgical patients: one right diaphragmatic hernia, one post-operative respiratory complication after intervention for neonatal occlusion. In 9 cases the newborn was under controled artificial ventilation associated with PEEP at 5 to 7 cm of water. In all of the cases, the hemodynamic, metabolic and blood gas conditions were normal. A control series of 11 newnorn was carried out in a pediatric unit, the clearance was done without urine samples, the rough value of the figures found varied from 5.5 ml per minute to 30 ml per minute in the respiratory distress series and 16 to 62 ml per minute in the control series. The analysis of these results in rendered difficult by the juxtaposition of several factors: Choice of a reference criterion: body surface area, PAH space, patient's weight theoretical weight of the kidneys. The factor of prematurity. The problem of the date of the investigation in comparison with the date of birth.
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PMID:[PAH clearance measurement without urine samples in the newborn infant with respiratory distress]. 0 69

The newborn infant with a congenital diaphragmatic hernia (CDH) who develops severe respiratory distress requiring operative repair within the first 24 hours of life represents one of the most challenging problems in pediatric surgery. The mortality in these infants still exceeds 50% and has historically been attributed to ventilatory insufficiency secondary to pulmonary hypoplasia. However, the primary abnormality in these neonates seems to be an increase in pulmonary vascular resistance with an elevation of pulmonary artery pressure, right-left ductal shunting, preductal shunting and progressive hypoxemia. Eighteen neonates with a CDH were operated upon within the first 24 hours of life with a mortality of 38%. In no instance did ventilatory insufficiency seem to be a major factor in the death of the patient. Seven infants with progressive hypoxemia were treated with a vasodilator, tolazoline. Six of the seven infants showed an initial response to treatment, with a rise in preductal PaO2 and a decrease in ductal shunting. Four of these seven desperately ill neonates survived. Pathologic examination of the pulmonary vasculature in the non-survivors revealed an increase in muscle mass within the pulmonary arterioles. An exaggerated vasoconstrictive response of an abnormally hypertrophied pulmonary vascular bed leading to an elevation of pulmonary vascular resistance, rather than abnormalities of ventilation, appears to be the important mechanism leading to the often fatal hypoxemia observed in the neonate with a CDH. Improved survival will depend upon the successful management of the deranged pulmonary vascular hemodynamics seen in these infants.
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PMID:Congenital diaphragmatic hernia. New concept in management. 48 7

Some of the morphologic changes of bronchopulmonary dysplasia are frequently found in infants dying of the infantile respiratory distress syndrome, so the frequency of BPD is more frequent as determined morphologically than as determined clinically. Morphologic differences have been described between the lesions of oxygen poisoning and those of BPD, but there are probably no true qualitative differences and such differences as exist are quantitative ones. Clinical and functional studies suggest that lung damage in infancy and early childhood may result in residual functional abnormalities in older childhood, and to a predisposition to chronic airflow obstruction in later life. It is hypothesized that this may be brought about by alteration in postnatal lung growth. Two patients who had an operation for diaphragmatic hernia on the first day of life and who died 8 and 64 months later were used to illustrate this point, since both had obviously abnormal lung structure at the time of death.
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PMID:Morphologic aspects of bronchopulmonary dysplasia. 58 33

The most common causes of respiratory distress in the newborn and the frequently rapidly changing pulmonary pattern in the follow up studies are presented. Various degrees of the hyaline membrane disease and bronchopulmonary dysplasia are demonstrated as well as the different changes of the pulmonary pattern in controlled and assisted ventilation, recurrent atelectasis, dystelectasis, emphysema, pneumothorax and pneumomediastinum. Chest film follow up series are demonstrated. The differential diagnosis includes pulmonary aspiration syndrome, the neonatal pneumonia and emergency cases in pediatric surgery (here an example of a congenital diaphragmatic hernia).
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PMID:[Alterations of pulmonary patterns in roentgenographic follow up studies in respiratory distress of newborns and prematures (author's transl)]. 70 33

In congenital diaphragmatic hernias, the presence of abdominal viscera in the thoracic cavity will arrest the development of the ipsilateral lung, and occasionally of the controlateral lung also. The lung may thus be either compressed or hypoplastic in varying degrees. Its state of development conditions the prognosis of this disease. In severe forms, known as "High Risk" forms, presenting in the 3 first days of life with respiratory distress, the lung is very often hypoplastic, the number of bronchial, bronichiolar and vascular generations is diminished. The airways pulmonary function in medium and long term has been studied in 10 children over a period of 3 to 15 years. The clinical radiological, scannery and fonctional lung study results present not unfrequently signs of overdistention, of obstructive disease, and pulmonary bronchectasis on the side of the hernia. The evolution could be explained by the normal post natal multiplication of airways as well as by an increase of their size in such a manner as to occupy the whole thoracic cavity.
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PMID:[The lungs in congenital diaphragmatic hernias (author's transl)]. 70 14

Sixteen moribund newborn infants with respiratory failure were treated with extracorporeal membrane oxygenation (ECMO) for 1 to 8 days. Cannulation via the right jugular vein and carotid artery was used to establish venoarterial-cardiopulmonary bypass. High flow (80 percent of cardiac output) allowed decreasing FIO2 and airway pressure. Diagnoses and results were as follows: respiratory distress syndrome, four patients (two improved, one survived); meconium aspiration syndrome, eight patients (four improved, three survived); persistent fetal circulation (some with diaphragmatic hernia), four patients (three improved, two survived). Intracranial bleeding occurred in 43 percent, accounting for most of the deaths. In a parallel series of 21 infants treated with conventional ventilator therapy, the mortality rate was 90 percent and intracranial bleeding occurred in 57 percent. ECMO provided life support and gains time in newborn respiratory failure. In high mortality risk infants, the rate of survival is higher and intracranial bleeding lower with ECMO than with optimal ventilator management.
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PMID:Extracorporeal circulation (ECMO) in neonatal respiratory failure. 92 12

The developmental characteristics of infants surviving the neonatal period after the performance of prenatal intra-uterine transfusions because of severe rhesus haemolytic disease were studied in 17 of 19 children, using the revised Denver Developmental Screening Test and a physical-neurological examination. The children ranged in age from 5 to 91 months. Two cases are reported as having retared psychomotor development. No cases of cerebral palsy were found. Among the minor abnormalities were squints, abdominal hernia and enamel defects. The results justify the use of intra-uterine transfusions in appropriately selected fetuses when combined with treatment of hyperbilirubinaemia and respiratory distress during the neonatal period.
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PMID:A follow-up study of infants who received intra-uterine transfusions because of severe rhesus haemolytic disease. 106 13

One hundred ten infants with congenital diaphragmatic hernia (CDH) developed life-threatening respiratory distress in the first 6 hours of life. Associated anomalies were present in 33%. Twenty-eight of 65 infants (43%) treated before 1987 (pre-extracorporeal membrane oxygenation [ECMO] era) survived after immediate CDH repair, and mechanical ventilation with or without pharmacologic support. Only two of 16 (12.5%) infants requiring a prosthetic diaphragmatic patch survived. Since 1987, 31 of 46 (67.4%) infants with birth weight, gestational age, and severity of illness similar to the pre-1987 group survived. All patients were immediately intubated and ventilated. Seven (four with lethal chromosomal anomalies) infants died before treatment, and 30 stabilized (partial pressure of carbon dioxide [PCO2] < 50; partial pressure of oxygen [PO2] > 100; pH > 7.3) and underwent delayed CDH repair at 5 to 72 hours. Fifteen did well on conventional support and survived. Fifteen infants deteriorated after operation: 11 were placed on ECMO with eight survivors, and four infants were not considered ECMO candidates. Nine babies failed to stabilize initially and were placed on ECMO before CDH repair (alveolar-arterial gradient > 600 and oxygenation index > 40), and seven survived. The overall survival rate was 80% at 3 months in this ECMO-treated group. Early mortality was due to inability to wean from ECMO (one), intracranial hemorrhage (one), liver injury (one), and pulmonary hypoplasia (one). Nine of 11 babies requiring a prosthetic patch in the post-1987 ECMO group survived (81.8%). There were three late post-ECMO deaths (3 to 18 months) of right heart failure (two) and sepsis (one). Symptomatic gastroesophageal reflux occurred in nine cases, six requiring a fundoplication in the bypass babies. Recurrent diaphragmatic hernia occurred in nine cases (five ECMO). The overall survival rate was significantly improved in the delayed repair/ECMO group (67% versus 43%; p < 0.05) and was most noticeable in infants requiring a prosthetic diaphragm (81.2% versus 12.5%; p < 0.005). These data indicate that early stabilization, delayed repair, and ECMO improve survival in high-risk CDH. Early deaths are related to pulmonary hypertension and can be reversed by ECMO.
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PMID:Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia. 141 95

A young woman with a history of diaphragmatic hernia presented to the hospital in respiratory distress and in premature labor. Her admission chest roentgenogram showed opacification of the left hemithorax, and her arterial blood gas analysis revealed hypoxemia. Emergency cesarean section and exploratory left thoracotomy were carried out; a large tumor occupied the left side of the chest, and pneumonectomy was performed. No diaphragmatic hernia was present. A pathologic diagnosis of primary liposarcoma was made.
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PMID:Pleural liposarcoma presenting with respiratory distress and suspected diaphragmatic hernia. 144 14

From 1977 to 1991, 136 neonates have had corrective surgery for diaphragmatic hernia at Children's Hospital of Los Angeles. A retrospective study was performed to determine how many of the 136 neonates had defects large enough to require the use of a prosthetic patch to repair the defect. Twelve were found. All 12 were symptomatic at birth for respiratory distress. Mean arterial blood gas values at birth were pH 6.95, PCO2 94.8, and PO2 47.2. The mean oxygen index (n = 10) was 61.8. Six of these patients were repaired without extracorporeal membrane oxygenation (ECMO) support while the other six received ECMO bypass perioperatively. All six of the patients who did not receive ECMO support died despite successful diaphragmatic repair. Five of six patients who received ECMO perioperatively survived (83%). These surviving infants are now between 1 month and 4 years of age. In the survivors, four of five required subsequent repair and patch enlargement for a recurrent diaphragmatic hernia. Gastroesophageal reflux, requiring a Nissen fundoplication in two infants, complicated the course of three survivors. Four survivors were discharged with supplemental oxygen therapy lasting less than 13 months. Patch disruption is predicted to occur at approximately 18 months of age in all patients, especially if little or no muscle was available at primary repair for prosthetic attachment. These children should be followed closely for feeding or respiratory symptoms. Diagnosis of patch disruption can be made by chest x-rays and confirmed by contrast studies. Patch expansion by laparotomy and careful search for additional musculature for patch attachment is recommended when reherniation occurs.
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PMID:ECMO and the management of congenital diaphragmatic hernia with large diaphragmatic defects requiring a prosthetic patch. 150 Oct 39


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