2001 OPEN FORUM Abstracts
MANAGEMENT OF A DIAPHRAGMATIC HERNIA IN A NEONATE USING A CONTINUOUS INTRAVASCULAR BLOOD GAS SENSOR: A CASE REPORT
Catherine Worwa RCP, PatriciaMeyers RRT, Mark C. Mammel MD. Children?s Hospitals and Clinics, St. Paul, Minn.
BACKGROUND: Congenital DiaphragmaticHernia (CDH) occurs in one of every 2000-5000 births and has a high morbidityand mortality. The survival of the newborn with CDH is dependent on the degreeof lung maturity and the presence and reversibility of pulmonary hypertension.Hypoxia, hypercapnia, acidosis and hypothermia, precipitate pulmonary hypertension.Preventing these triggers during the immediate newborn period is crucial ifan infant with a CDH is to survive.
CASE SUMMARY: The patientwas a 40 week gestation male, 3.4 Kg, admitted to our NICU from an outlyinghospital with respiratory distress and suspicion of diaphragmatic hernia perx-ray. Labor was complicated with decels late and meconium fluid. Infant wasborn vaginally. Apgar scores were 5 & 9 at 1 and 5 minutes. Spontaneousrespiration occurred within 15-30sec; breath sounds reduced on left with scatteredcrackles. O2 was administered via mask. The infant soon displayed tachypneaand grunting with retractions. Saturations were 94% on FiO2 .27. No heart murmurwas detected. Mediastinam and trachea were shifted to the right. Abdomen wasscaphoid. No hepatosplenomegaly. Genitalia, lung, head & ENT, and reflexesall normal. Pt was transferred and admitted to NICU. Continuous blood gas monitoringusing Neotrend (Agilent Tech.) revealed that the patient could maintain ABGhomeostasis without intubation. Day 2, the patient was weaned off oxygen toroom air. Day 3 patient went to surgery. Post op vent settings: Dräger Babylog,PSG+VG Rate 30, 24/3 Vt 12,FiO2 .21. Total mechanical ventilation <96 hours.Surgical findings: Left congenital diaphragmatic hernia with intact hernia sac.
DISCUSSION: This defect wasan atypical diaphragmatic hernia. With the use of continuous blood gas monitoring,mechanical ventilation was delayed until the defect could be surgically resolved.