新生儿巨大膈疝误诊1例报告

膈疝是较常见的先天性畸形之一,但巨大膈疝少见,我们于2002年1月误诊1例,报告如下.     

新生儿巨大膈疝误诊1例报告

膈疝是较常见的先天性畸形之一,但巨大膈疝少见,我们于2002年1月误诊1例,报告如下。 病例:患儿,男,日龄15小时,体重3 250g,G_2P_1,足月顺产。Apgar评分1分钟10分。羊水清。以呼吸急促、青紫1小时住院。体检:心率140次/分,呼吸60次/分。烦躁、口     

新生儿先天性膈疝报告1例

病例 患儿男,体重2900 g,第1胎孕40周正常分娩,无早破膜史。出生时羊水Ⅲ°胎粪污染,脐带28 cm,Apgar评分1分,心跳60次/分,即刻复苏保暖,清理呼吸道,气管插管加压给氧,心外按压,5分钟Apgar评分1分,于胸骨柄右缘心尖搏动点行心内注射肾上腺素0.1mg,心跳增至80次/分,仍无自主呼吸,皮肤灰白,Apgar评分10分钟,15分钟,25分钟均1分,心跳缓慢,生后30分钟心跳停止,终止复苏。查体:营养发育正常,皮肤苍     

新生儿先天性膈疝报告1例

病例患儿男,体重2900 g,第1胎孕40周正常分娩,无早破膜史.出生时羊水Ⅲ°胎粪污染,脐带28 cm,Apgar评分1分,心跳60次/分,即刻复苏保暖,清理呼吸道,气管插管加压给氧,心外按压,5分钟Apgar评分1分,     

先天性膈疝合并肺炎1例

1 病历摘要 患儿，男，2个月。患儿系第一胎足月剖宫产，出生后Apgar评分10分。生后2h出现呼吸急促、口周发绀，哭闹时明显，出生6h后，喂水时出现呛咳、喘憋、鼻煽、口周青灰，左肺听诊呼吸音弱，胸透发现左胸腔内实变阴影，生后8h以新生儿肺炎转入新生儿病房，经半月多的抗感染、持续吸氧、多次少量输新鲜血液等支持治疗，呼吸困难及喘憋、呛咳症状持续存在，肺内炎症时好时坏。胸腔内实变阴影可见改变。超声波检查肝、胆、胰均正常。左上腹腔内未查到脾脏。钡透食管未见异常，但胃底疝人左胸腔内。诊断左侧先天性膈疝合并新生儿肺炎，疝的内容物为脾脏和胃底。2005年7月5日，在全麻下插管行开胸手术，术后经15天治疗痊愈出院。     

先天性膈疝伴两肺极度发育不良1例

女婴,G_2P_2,足月顺产。生后不哭,全身皮肤微呈青紫。抢救后略有微弱哭声。检查:右乳下1.5cm处见有规律搏动,听诊心音强而清晰,律齐。腹部略隆。因呼吸弱而不规则,且进行性加重,于生后半小时死亡。临床疑为“右位心”。尸解见横膈左后部有     

新生儿先天性膈疝1例误诊分析

患儿，男，5天，因生后气喘3天伴发热半天入院。系第二胎、第二产，足月顺产，无窒息史，生后第二天出现恶心，呕吐少许粘液，第三天出现气喘，吮乳减少，无呛咳史，入院当日上午发热，气喘加重、拒乳。体检：体温38．2C，脉搏110次／分，呼吸48次／分。生长发育正常，哭声可，面色微纣，四周青紫，皮肤粘膜无黄染，皮下无出血点及瘀斑。前囱平坦，瞳孔等大，对光反射存在，胸廓无畸形，可见轻度吸气性凹陷，双肺闻及散在湿音，右肺呼吸音稍低。心律齐，心音有力，腹平软、肝脾不大。拥抱反射存在，觅食反射未引出。拟诊：新生儿肺炎，败血…     

先天性巨大膈疝一例

患儿,女,因出生后呼吸困难15min入院.系G1P1,足月正常产,母妊娠期顺利,妊娠期饮水较多,生后Apgar评分:1 mm.7分,5 min 8分.羊水量700 ml,无脐带绕颈,羊水无污染.生后即有呼吸困难,哭声小,口鼻腔有大量白色稀薄分泌物,由产科入我科.     

新生儿膈疝误诊为肺炎1例分析

1病历摘要 患儿，女，6天，G2P2，胎龄36周，于自家中顺产后请当地产科医生新法断脐，出生体重1800g，阿氏评分7分，生后有哭声，弱。因口吐泡沫、口唇紫绀，食奶后加重，咳嗽、拒乳10h入院，发病后无呕吐，易呛奶。其母第1胎，男，胎龄36周，顺产，出生时因脐带过短，生后已死亡，且2次妊娠均无产前保健。     

先天性膈疝肺发育不良的研究进展

先天性膈疝(congenital diaphragmatic hernia,CDH)是由于单侧或双侧膈肌发育缺损,导致腹腔内脏器官疝入胸腔的一种先天性疾病.其发病率约为1/2.500(如包含死产在内,约为1/2 000)~([1]).CDH的病因及分子生物学机制尚未明了,目前仍无有效的治疗手段从根本上改变其合并的肺发育不良;临床上,尽管对CDH患儿进行了积极的对症支持及相应的外科手术治疗,重症病例的死亡率仍达50%～60%,而双侧CDH患儿的死亡率更是高达100%~([2-3]).目前,对CDH的研究已成为一个热点,其临床治疗的效果常常是衡量新生儿科综合治疗水平的一个重要的指标.本文就目前CDH肺发育不良的病因及诊疗进展作如下慨述.     

Extralobar sequestration with congenital diaphragmatic hernia: a complicated case study

This article presents a case study of an infant (JG) with an antenatal diagnosis of a left diaphragmatic hernia and an extralobar sequestration of his right lung, which was noted postnatally. JG's course was complicated by persistent pulmonary hypertension of the newborn (PPHN) and suspected pulmonary hypoplasia, and he required support with extracorporeal life support (ECLS). JG's case was unusual in his presentation of extreme PPHN that was unresponsive to inhaled nitric oxide and ECLS. His PPHN was nearly intractable, requiring treatment with vasodilators combined with intravenous sildenafil, which had never been tried in our institution before this case. The article concludes with a discussion of the etiology, diagnosis, and management of congenital diaphragmatic hernia and extralobar sequestration, singly and in combination.     

Late manifestation of congenital diaphragmatic hernia - case report

Congenital diaphragmatic hernia (CDH) in most cases presents immediately or within hours after birth with signs of respiratory failure: dyspnea, tachypnea, and cyanosis. Late presentation of CDH (beyond the neonatal period) is less common and represents true diagnostic challenge. Diagnosis of the defect is difficult. Symptoms are non-specific and can be misleading. Late onset of this anomaly must be considered in the differential diagnosis of chronic gastrointestinal or respiratory symptoms. The aim of this report is a case of 17 year old boy with delayed presentation of congenital diaphragmatic hernia.     

The cardiopulmonary consequences of high-risk congenital diaphragmatic hernia

The cardiopulmonary effects of high-risk congenital diaphragmatic hernia have been studied in 50 neonates at The Children's Hospital Boston, from October 1982 through February 1987. Extracorporeal membrane oxygenation (ECMO) was added in February 1984 as therapy for infants who failed to respond to conventional therapy and had 100% predicted mortality. Twenty-three patients received ECMO support; 19 underwent cardiac catheterization immediately after surgery and had hemodynamic parameters measured and pulmonary angiograms performed. The infants fell into two physiologic groups based on their ability to achieve a postductal P O₂ 100: responders and nonresponders to conventional therapy. Responders most often began with left-to-right shunting, and therefore had a pulmonary vascular bed large enough to accept a full cardiac output, even though it was hypoplastic. Their episodes of right-to-left shunting were mostly caused by severe pulmonary aterial vasospasm, which could be reversed in many instances. Nonresponders never showed an ability to accept a cardiac output, and therefore had severe hypoplasia as a limiting condition. Survival was 68% in the responders and 8% in the nonresponders. Overall survival was 49%. Of the patients placed on ECMO, 82.6% were weaned successfully but 65.2% died eventually, most often due to complications of chronic ventilator support. Preliminary analysis of the lungs demonstrated significant iatrogenic damage, but showed some evidence of pulmonary growth. These data suggest that if support can be provided with less iatrogenic injury after ECMO, pulmonary vascular remodeling and growth may be sufficient for improved survival. Offprint requests to: J. P. Vacanti at the Children's Hospital     

Acute gastric volvulus and congenital diaphragmatic hernia,case report and review

Congenital diaphragmatic hernia (CDH) is the result of the incomplete fusion and closure of the pleuroperitoneal canal during the fetal development. CDH is usually diagnosed prenatally but, if undiagnosed, the clinical presentation ranges from asymptomatic children to serious respiratory or gastrointestinal symptoms. Acute gastric volvulus associated with CDH is a rare surgical emergency in children. We report two cases of acute gastric volvulus associated with CDH and review the literature.Key words: Acute gastric volvulus, children, congenital diaphragmatic hernia, gastropexy     

Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphologic assessment

We carried out a prospective study in 66 infants with congenital diaphragmatic hernia within the first 6 hours of life to determine whether outcome is related to the degree of underlying pulmonary hypoplasia, as predicted by preoperative PaCO2, when correlated with an index of ventilation (VI = mean airway pressure X respiratory rate) and confirmed by postmortem analysis of the lung. Those infants with PaCO2 greater than 40 mm Hg before surgery had a 77% mortality; when PaCO2 reduction could be achieved only with VI greater than 1000, the mortality was still greater than 50%. After repair, however, the ability to hyperventilate to PaCO2 less than 40 mm Hg proved to be an important determinant of survival; only one of 31 infants in this group died, whereas only two of 27 infants with PaCO2 greater than 40 mm Hg survived. In 16 infants with PaCO2 greater than 40 mm Hg despite hyperventilation, high-frequency oscillatory ventilation was started. This resulted in a rapid fall in PaCO2, but 14 of the 16 infants had only temporary improvement in oxygenation, and died. In five of the infants who died, alveolar number was assessed by postmortem morphometric analysis; there was a severe reduction to less than 10% of published normal neonatal values. Pulmonary vascular changes of increased muscularization were less remarkable than those observed in infants with persistent pulmonary hypertension. Our findings suggest that the degree of pulmonary hypoplasia (which would not be influenced by surgical repair), rather than the pulmonary vascular abnormality, mainly determines survival. Consideration could therefore be given to an initial nonsurgical approach to congenital diaphragmatic hernia, with the expectation that pulmonary function might improve and pulmonary vascular resistance decrease.     

A case of congenital diaphragmatic hernia with intradiaphragmatic pulmonary sequestration: case report and literature review

Extralobar pulmonary sequestration (EPS) can occasionally be found incidentally in congenital diaphragmatic hernia (CDH). Extralobar pulmonary sequestration usually arises in the chest or the abdomen; rarely in the diaphragm. We report a neonatal case of antenatally diagnosed CDH associated with intradiaphragmatic EPS.