pediatrics
Diaphragmatic Hernia
Treatment of Diaphragmatic Hernia
Surgical repair If diaphragmatic hernia is suspected in a neonate with respiratory distress, the neonate should be immediately endotracheally intubated and ventilated in the delivery room. Bag-and-mask ventilation should be avoided because it may fill the displaced intrathoracic viscera with air and worsen respiratory compromise. Continuous nasogastric suction with a double-lumen nasogastric tube prevents swallowed air from progressing through the gastrointestinal tract and causing further lung compression. Surgery is required to replace the intestine in the abdomen and to close the diaphragmatic defect after the neonate's oxygenation, acid-base balance, and blood pressure have been optimally managed. Avoid bag-and-mask ventilation in neonates with respiratory distress due to diaphragmatic hernia because it may further inflate the displaced intrathoracic viscera. Severe persistent pulmonary hypertension requires stabilization before surgery with inhaled nitric oxide, which may help dilate the pulmonary arteries and improve systemic oxygenation. Studies show improved outcome with use of extracorporeal membrane oxygenation (ECMO); however, neonates with extreme pulmonary hypoplasia still do not survive. Successful transport of a critically ill neonate with congenital diaphragmatic hernia and persistent pulmonary hypertension is very difficult. Therefore, if a diaphragmatic hernia is diagnosed by prenatal ultrasonography, delivery at a pediatric center with ECMO facilities is recommended. 