Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite advances in neonatal care including prenatal diagnosis, conventional ventilation, surfactant, high frequency oscillation, nitric oxide and extracorporeal membrane oxygenation (ECMO) the diagnosis of CDH is reported to carry a high mortality rate. Pulmonary hypoplasia and persistent pulmonary hypertension are major factors that contribute to death. In an effort to improve the survival of these infants a protocolized approach was adopted. In summary, this involves antenatal use of steroids if CDH antenatally diagnosed, sedation and muscle relaxation following tracheal intubation, administration of surfactant, gentle ventilation with permissive hypercapnia, trial of nitric oxide, preoperative ECMO for those infants failing therapy and delayed repair of the CDH. With the use of this protocolized approach the survival of infants with isolated CDH was 96 % for inborn and 81 % for outborn infants.
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PMID:Improving survival of neonates with isolated congenital diaphragmatic hernia. 1559 64

Owing to recent advances in minimally invasive surgery (MIS), laparoscopic and thoracoscopic surgery have been gradually introduced for use in neonates and infants. This review focuses on two popular MIS procedures for diaphragmatic diseases in neonates and infants: congenital diaphragmatic hernia (CHD) repair and plication for diaphragmatic eventration. While several advantages of MIS are proposed for CDH repair in neonates, there are also some concerns, namely intraoperative hypercapnia and acidosis and a higher recurrence rate than open techniques. Thus, neonates with severe CDH, along with an unstable circulatory and respiratory status, may be unsuitable for MIS repair, and the use of selection criteria is, therefore, important in these patients. It is generally believed that a learning curve is associated with the higher recurrence rate. Contrary to CDH repair, no major disadvantages associated with the use of MIS for diaphragmatic eventration have been reported in the literature, other than technical difficulty. Thus, if technically feasible, all pediatric patients with diaphragmatic eventration requiring surgical treatment are potential candidates for MIS. Due to a shortage of studies on this procedure, the potential advantages of MIS compared to open techniques for diaphragmatic eventration, such as early recovery and more rapid extubation, need to be confirmed by further studies.
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PMID:Minimally invasive surgery for diaphragmatic diseases in neonates and infants. 2724 8