Michael Halim,Albert You,Hana Christyanti,Adhie Nur Radityo,Rinawati Rohsiswatmo
Background : The survival rate of congenital diaphragmatic hernia (CDH) has greatly improved under new ventilation methods and advances in neonatal intensive care unit (NICU).Depending on the size of the defect, CDH severity is mostly related to the degree of hypoplasia and how early in gestation the abdomen contents were displaced. Most centers target the use of gentle ventilation and the recommendation includes the use of high frequency oscillatory ventilation (HFOV) as the primary care.
Case Presentation Summary : A baby girl (38 weeks GA, 2700 gram) was born through caesarean section with good muscle tone, chest retraction, and HR>100 x/minute. During resuscitation, intubation with HFOV (MAP 12, Amp 30, FiO2 30%) was applied at 2.5 minute of age. Chest retraction disappeared completely at 10 minute of age and the baby was transported to NICU. CDH was known from antenatal ultrasound and chest x-ray. ECHO result shows normal heart with no persistent pulmonary hypertension (PPHN). At the age of 5 day, hernia was repaired in NICU with chest water seal drainage (WSD) applied. At the age of 8 day, the lung expanded completely and HFOV was weaned to CPAP and later to spontaneous breathing. Antibiotics were given for 7 days despite sterile blood culture.
Learning Points/Discussion : In patients with antenatal diagnosed CDH, the prognosis depends on both the degree of lung hypoplasia and PPHN after their birth. The major advantage of HFOV is improved oxygenation and ventilation through the use of small tidal volumes thereby decreasing iatrogenic pulmonary barotrauma. Early HFOV adoption appears to reduce mortality. This case discloses good outcome of early HFOV and has shorter length of staying NICU and hospital.
Keywords: congenital diaphragmatic hernia high frequency oscillatory ventilation persistent pulmonary hypertension
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